Provider Demographics
NPI:1518939420
Name:KRITZER, GORDON LEE (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:LEE
Last Name:KRITZER
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 1:1100 9TH AVE
Mailing Address - Street 2:MS:M4-PFS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029582207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA060025977OtherRAILROAD MEDICARE
WAKR4228OtherSNOHOMISH COUNTY
WA806382700OtherIDAHO MEDICAID
WA8142697Medicaid
WAMD450WAOtherALASKA MEDICAID
WAKR4228OtherINDIVIDUAL BLUE SHIELD
WAKR4228OtherINDIVIDUAL BLUE SHIELD
WA060025977OtherRAILROAD MEDICARE
WA806382700OtherIDAHO MEDICAID
WA8802285Medicare PIN
WA8802283Medicare PIN