Provider Demographics
NPI:1679643563
Name:STRONG, GARY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:STRONG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 FOWLER ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4719
Mailing Address - Country:US
Mailing Address - Phone:509-783-2004
Mailing Address - Fax:509-783-1949
Practice Address - Street 1:1305 FOWLER ST STE 1C
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-783-2004
Practice Address - Fax:509-783-1949
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005045363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8942102OtherDL&I CV#
WA8357337Medicaid