Provider Demographics
NPI:1790820546
Name:WAKELIN, DONALD E (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:WAKELIN
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 1:1211 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2562
Mailing Address - Country:US
Mailing Address - Phone:360-299-4945
Mailing Address - Fax:360-299-4269
Practice Address - Street 1:1213 24TH ST STE 700
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2593
Practice Address - Country:US
Practice Address - Phone:360-299-5142
Practice Address - Fax:360-299-4269
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047631207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA263670OtherLABOR & INDUSTRIES
WAG8893761Medicare PIN