Provider Demographics
NPI:1598977746
Name:ENDERS, RICHARD ALLEN JR (PAC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALLEN
Last Name:ENDERS
Suffix:JR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14611 NE 165TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-9610
Mailing Address - Country:US
Mailing Address - Phone:360-256-7344
Mailing Address - Fax:360-256-7344
Practice Address - Street 1:9430 NE VANCOUVER MALL DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6172
Practice Address - Country:US
Practice Address - Phone:360-253-6947
Practice Address - Fax:360-448-6324
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10000092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-1878809OtherTAX ID