Provider Demographics
NPI:1831170927
Name:VERSCHUYL, EVERT-JAN (MD)
Entity type:Individual
Prefix:DR
First Name:EVERT-JAN
Middle Name:
Last Name:VERSCHUYL
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:3417 ENSIGN RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5075
Practice Address - Country:US
Practice Address - Phone:360-493-4609
Practice Address - Fax:360-493-4603
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000308712085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0417786OtherL&I-RADIA KING CTY
WA0384715OtherL&I-RADIA REST OF WA
WA1045847Medicaid
WA0114512OtherL&I-SOUTH SOUND RADIOLOGY
WA0405724OtherL&I-SEATTLE RADIOLOGY
WA0417788OtherL&I-SWEDISH RADIA EDMONDS
WA0417790OtherL&I-EVERGREEN RADIA