Provider Demographics
NPI:1255693909
Name:ANDELIN, GARY RHETT (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RHETT
Last Name:ANDELIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:G.
Other - Middle Name:RHETT
Other - Last Name:ANDELIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:9631 - 269TH STREET NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292
Practice Address - Country:US
Practice Address - Phone:360-629-1600
Practice Address - Fax:360-629-1644
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60546093207P00000X, 207Q00000X
IA9461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine