Provider Demographics
NPI:1134308380
Name:AGAN, WILLIAM A
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:AGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18012 W VALLEY HWY
Mailing Address - Street 2:# 101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2924
Mailing Address - Country:US
Mailing Address - Phone:425-656-5412
Mailing Address - Fax:425-656-4096
Practice Address - Street 1:16850 SE 272ND ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4931
Practice Address - Country:US
Practice Address - Phone:253-395-1960
Practice Address - Fax:253-395-2013
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATA10005277363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant