Provider Demographics
NPI:1235191958
Name:ADDISON, DANNY GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:GEORGE
Last Name:ADDISON
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 1:828 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6419
Mailing Address - Country:US
Mailing Address - Phone:360-452-4741
Mailing Address - Fax:360-457-6742
Practice Address - Street 1:828 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6419
Practice Address - Country:US
Practice Address - Phone:360-452-4741
Practice Address - Fax:360-457-6742
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1672005Medicaid
WA17304OtherLABOR & INDUSTRIES
WAA15692Medicare UPIN
WA17304OtherLABOR & INDUSTRIES