Provider Demographics
NPI:1487885133
Name:ALONSO, PATRICK G (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:G
Last Name:ALONSO
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 1:4311 11TH AVENUE NE, SUITE 200
Mailing Address - Street 2:MEDEX NORTHWEST
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-616-4001
Mailing Address - Fax:
Practice Address - Street 1:4311 11TH AVENUE NE, SUITE 200
Practice Address - Street 2:MEDEX NORTHWEST
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-616-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1710I1003X
AK105297363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians