Basic Information
| Provider Information | |||||||||
| NPI: | 1255693909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDELIN | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | RHETT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANDELIN | ||||||||
| OtherFirstName: | G. | ||||||||
| OtherMiddleName: | RHETT | ||||||||
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| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1400 E KINCAID ST | ||||||||
| Address2: | ATTN: CREDENTIALING | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604282500 | ||||||||
| FaxNumber: | 3604286485 | ||||||||
| Practice Location | |||||||||
| Address1: | 9631 - 269TH STREET NW | ||||||||
| Address2: | |||||||||
| City: | STANWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606291600 | ||||||||
| FaxNumber: | 3606291644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2012 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OP60546093 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 9461 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OP60546093 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.