Basic Information
Provider Information
NPI: 1730228420
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GETZ
FirstName: JEREMY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2980 SQUALICUM PKWY
Address2: SUITE 304
City: BELLINGHAM
State: WA
PostalCode: 982251880
CountryCode: US
TelephoneNumber: 3606473377
FaxNumber: 3607523214
Practice Location
Address1: 2980 SQUALICUM PKWY
Address2: SUITE 304
City: BELLINGHAM
State: WA
PostalCode: 982251880
CountryCode: US
TelephoneNumber: 3606473377
FaxNumber: 3607523214
Other Information
ProviderEnumerationDate: 02/06/2007
LastUpdateDate: 06/29/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XOP60070568WAY Allopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
854167405WA MEDICAID


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