Provider Demographics
NPI:1649275926
Name:GENDREAU, JOSEPH LEE (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEE
Last Name:GENDREAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 144TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8289
Mailing Address - Country:US
Mailing Address - Phone:425-327-9277
Mailing Address - Fax:
Practice Address - Street 1:2914 144TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-8289
Practice Address - Country:US
Practice Address - Phone:425-327-9277
Practice Address - Fax:360-652-7646
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging