Provider Demographics
NPI:1023039153
Name:GERRISH, WILLIAM BRADLEE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRADLEE
Last Name:GERRISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2330
Mailing Address - Country:US
Mailing Address - Phone:360-568-1554
Mailing Address - Fax:360-568-1722
Practice Address - Street 1:629 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2330
Practice Address - Country:US
Practice Address - Phone:360-568-1554
Practice Address - Fax:360-568-1722
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109701Medicaid
WAAB20852Medicare PIN
WA1109701Medicaid