Provider Demographics
NPI:1467497321
Name:LANDRETH, DUNCAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:DUNCAN
Middle Name:T
Last Name:LANDRETH
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 1:1400 E KINCAID ST
Mailing Address - Street 2:SKAGIT REGIONAL CLINICS, 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 1:307 S. 13TH STREET, SUITE 300
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4109
Practice Address - Country:US
Practice Address - Phone:360-336-9757
Practice Address - Fax:360-336-2088
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020573207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1467497321Medicaid
WA263566OtherLABOR & INDUSTRIES
WAG8892606Medicare PIN
WA263566OtherLABOR & INDUSTRIES