Provider Demographics
NPI:1689743197
Name:LETTERIE, GERARD S (DO)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:S
Last Name:LETTERIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 NE 130TH LANE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-284-4400
Mailing Address - Fax:425-899-9803
Practice Address - Street 1:12333 NE 130TH LANE
Practice Address - Street 2:SUITE 220
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-284-4400
Practice Address - Fax:425-899-9803
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001329207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F09839Medicare UPIN