Provider Demographics
NPI:1578659413
Name:ANDERSON, GILL EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:GILL
Middle Name:EARL
Last Name:ANDERSON
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 1:13030 121ST WAY NE
Mailing Address - Street 2:#202
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:90034-3008
Mailing Address - Country:US
Mailing Address - Phone:425-821-2020
Mailing Address - Fax:425-823-8273
Practice Address - Street 1:13030 121ST WAY NE
Practice Address - Street 2:#202
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:90034-3008
Practice Address - Country:US
Practice Address - Phone:425-821-2020
Practice Address - Fax:425-823-8273
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015271207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1738707Medicaid
WA1738707Medicaid