Provider Demographics
NPI:1700950425
Name:PRITCHARD, GREGORY A (PA-C)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:PRITCHARD
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 1:11917 E BROADWAY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6011
Mailing Address - Country:US
Mailing Address - Phone:095-816-2037
Mailing Address - Fax:095-934-1409
Practice Address - Street 1:11917 E BROADWAY AVE STE 102
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6011
Practice Address - Country:US
Practice Address - Phone:509-979-2164
Practice Address - Fax:509-979-2164
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10003934363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8348617Medicaid
WAI35605Medicaid
WAA45051Medicare ID - Type Unspecified