Basic Information
| Provider Information | |||||||||
| NPI: | 1619072196 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ENGLISH | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5127 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982065127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252583900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4027 HOYT AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982014972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253395489 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 12/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 15406 | WA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2083X0100X | MD00015406 | WA | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1014640 | 05 | WA | MEDICAID |