Provider Demographics
NPI:1659335602
Name:ZYLSTRA, PHILIP J (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:ZYLSTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 E. KINCAID ST.
Mailing Address - Street 2: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 1:3823 - 172ND ST NE
Practice Address - Street 2:CASCADE SKAGIT HEALTH ALLIANCE
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:360-618-5000
Practice Address - Fax:360-659-9834
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00027151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0080347OtherLABOR & INDUSTRIES
WA263664OtherLABOR & INDUSTRIES
R44189OtherREGENCE BLUE SHIELD
WA8117715Medicaid
B44592Medicare UPIN
WA0080347OtherLABOR & INDUSTRIES
001256502Medicare ID - Type Unspecified