Provider Demographics
NPI:1154404036
Name:DRAPER, GARY R (PA-C)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:DRAPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4302
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:3322 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:CA
Practice Address - Zip Code:98201-4425
Practice Address - Country:US
Practice Address - Phone:425-348-6727
Practice Address - Fax:425-339-8283
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA10002228363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1036316Medicaid
WAG8904049Medicare PIN
WAP40462Medicare UPIN