Provider Demographics
NPI:1932682705
Name:GALLAGHER, JEFFREY JAMES (PAC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JAMES
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 172ND ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-4753
Mailing Address - Country:US
Mailing Address - Phone:360-651-1550
Mailing Address - Fax:360-651-1560
Practice Address - Street 1:2335 172ND ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4753
Practice Address - Country:US
Practice Address - Phone:360-651-1550
Practice Address - Fax:360-651-1560
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61016039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant