Provider Demographics
NPI:1962484246
Name:WHIPPLE, ALAN E
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:E
Last Name:WHIPPLE
Suffix:
Gender:M
Credentials:
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 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-3335
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:3010 ST RT 109
Practice Address - Street 2:
Practice Address - City:COPALIS BEACH
Practice Address - State:WA
Practice Address - Zip Code:98535
Practice Address - Country:US
Practice Address - Phone:360-289-2427
Practice Address - Fax:360-289-9982
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB10496Medicare ID - Type Unspecified
F29497Medicare UPIN