Provider Demographics
NPI:1659462448
Name:CLINE, GARY DON (PAC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:DON
Last Name:CLINE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4011 TALBOT RD S
Mailing Address - Street 2:SUITE 500
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5773
Mailing Address - Country:US
Mailing Address - Phone:425-251-5110
Mailing Address - Fax:425-793-7376
Practice Address - Street 1:4011 TALBOT RD S
Practice Address - Street 2:SUITE 500
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5773
Practice Address - Country:US
Practice Address - Phone:425-251-5110
Practice Address - Fax:425-793-7376
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA10002668207RN0300X, 363AM0700X
IDPA506207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8373383Medicaid
000010143887OtherREGENCE BLUE SHIELD OF ID
ID805004000Medicaid
ID805004000Medicaid
970027981Medicare PIN
WAAB33452Medicare PIN