Provider Demographics
NPI:1770665309
Name:ANDERSON, GERALD W (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 123RD STREET CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8904
Mailing Address - Country:US
Mailing Address - Phone:253-627-0114
Mailing Address - Fax:253-627-0498
Practice Address - Street 1:3315 SO 23
Practice Address - Street 2:#200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-627-0114
Practice Address - Fax:253-627-0498
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015029208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AN5612OtherREGENCE
102486OtherLTI
WA1057264Medicaid
WA1057264Medicaid
A08300Medicare UPIN