Provider Demographics
NPI:1316001399
Name:IRVING, GORDON A (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:A
Last Name:IRVING
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 1:1101 MADISON ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1306
Mailing Address - Country:US
Mailing Address - Phone:206-386-2013
Mailing Address - Fax:206-386-2149
Practice Address - Street 1:1101 MADISON ST
Practice Address - Street 2:STE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1306
Practice Address - Country:US
Practice Address - Phone:206-386-2013
Practice Address - Fax:206-386-2149
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036551207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8235160Medicaid
WA0144876OtherLABOR AND INDUSTRIES
WA0144876OtherLABOR AND INDUSTRIES
WAAB20555Medicare ID - Type Unspecified