Basic Information
| Provider Information | |||||||||
| NPI: | 1497855308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEERMAN | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C/ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 4TH AVE | ||||||||
| Address2: | STE 301 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980339028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255761700 | ||||||||
| FaxNumber: | 4258277725 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 CARILLON PT | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980337306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255761700 | ||||||||
| FaxNumber: | 4258277725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 04/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP30000996 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363AM0700X | PA10003561 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 9602673 | 05 | WA | MEDICAID | 114811 | 01 | WA | LABOR AND INDUSTRIES | OTHER |