Provider Demographics
NPI:1144250572
Name:RAAPPANA, GREGORY B (PA-C)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
Last Name:RAAPPANA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:360-486-6508
Mailing Address - Fax:
Practice Address - Street 1:615 LILLY RD NE STE 220
Practice Address - Street 2:PMG SW WA NEUROSURGERY
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5137
Practice Address - Country:US
Practice Address - Phone:360-486-6150
Practice Address - Fax:360-486-6155
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003577363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8441891Medicaid
S51023Medicare UPIN