Provider Demographics
NPI:1720343296
Name:ANDEEN, GABRIEL K (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:K
Last Name:ANDEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 8TH AVE S.
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3033
Mailing Address - Country:US
Mailing Address - Phone:206-788-3617
Mailing Address - Fax:206-652-5216
Practice Address - Street 1:51377 SW OLD PORTLAND RD STE C
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-4023
Practice Address - Country:US
Practice Address - Phone:503-418-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD187010207Q00000X
WAMD60555323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine