Provider Demographics
NPI:1679506737
Name:STRODE, GERALD M (PA)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:M
Last Name:STRODE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 WALL ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1524
Mailing Address - Country:US
Mailing Address - Phone:206-448-6516
Mailing Address - Fax:206-448-6191
Practice Address - Street 1:521 WALL ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1524
Practice Address - Country:US
Practice Address - Phone:206-448-6516
Practice Address - Fax:206-448-6191
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10000421363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR12206Medicare UPIN
WAAB35535Medicare ID - Type Unspecified