Provider Demographics
NPI:1326186461
Name:EARLY, RONALD GAYLE (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:GAYLE
Last Name:EARLY
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 1:2505 2ND AVE
Mailing Address - Street 2:#600
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1452
Mailing Address - Country:US
Mailing Address - Phone:206-443-9091
Mailing Address - Fax:206-443-5434
Practice Address - Street 1:2505 2ND AVE
Practice Address - Street 2:#600
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1452
Practice Address - Country:US
Practice Address - Phone:206-443-9091
Practice Address - Fax:206-443-5434
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA15403174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1281005Medicaid
WA16093OtherLABOR & INDUSTRIES
WAA66167Medicare UPIN
WA1281005Medicaid