Provider Demographics
NPI:1790776607
Name:WILHOITE, RICHARD LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:WILHOITE
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:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-733-2092
Mailing Address - Fax:360-733-4013
Practice Address - Street 1:3015 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1945
Practice Address - Country:US
Practice Address - Phone:360-733-2092
Practice Address - Fax:360-733-4013
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
WAPA10004550363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0223437OtherL&I AND CRIME VICTIMS
WAP00465327OtherRAILROAD MEDICARE
WA9337210OtherAETNA
WA3011WIOtherREGENCE
WA8489874Medicaid
WA1790776607Medicaid
WA1790776607Medicaid