Provider Demographics
NPI:1962805226
Name:GILBRETH, RYAN A (PA-C)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:GILBRETH
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58572085R0202X, 363A00000X
WAPA609383112085R0204X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0406946OtherLNI-RADIA KING COUNTY
AZ981176Medicaid
WA0406948OtherLNI-EVERGREEN RADIA
WA0406945OtherLNI-RADIA REST OF WA
WA0406947OtherLNI-SWEDISH RADIA EDMONDS
WA0406949OtherLNI-SOUTH SOUND RADIOLOGY
WA0406950OtherLNI-SEATTLE RADIOLOGY
WA2128654Medicaid