Provider Demographics
NPI:1114948924
Name:LONNER, JOSEPH GUNNAR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GUNNAR
Last Name:LONNER
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 1:2980 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1880
Mailing Address - Country:US
Mailing Address - Phone:360-647-3377
Mailing Address - Fax:360-752-3214
Practice Address - Street 1:2980 SQUALICUM PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1880
Practice Address - Country:US
Practice Address - Phone:360-647-3377
Practice Address - Fax:360-752-3214
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044722207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8427668Medicaid
WAP00335868OtherMEDICARE RR
WA8427668Medicaid
I28626Medicare UPIN