Provider Demographics
NPI:1396734695
Name:PARTRIDGE, EUGENE W (PA-C)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:W
Last Name:PARTRIDGE
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 1:3021 GRIFFIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2369
Mailing Address - Country:US
Mailing Address - Phone:360-802-5010
Mailing Address - Fax:350-825-6536
Practice Address - Street 1:3021 GRIFFIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2369
Practice Address - Country:US
Practice Address - Phone:360-802-5010
Practice Address - Fax:350-825-6536
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10000553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8371999Medicaid
WAS45666Medicare UPIN
WA8371999Medicaid