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Individual
DEREK A GALLICHOTTE
Active
Individual
DEREK A GALLICHOTTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10001366
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039594
LABOR AND INDUSTRIES #
WA
05
—
8329294
—
WA
01
—
970001476
RAILROAD MC#
WA
01
—
GA0072
BLUE SHIELD #
WA
01
—
US2023376
AETNA SPECIALIST PIN
WA
Enumeration date
01/15/2007
Last updated
06/17/2008
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