Individual
DR. JORDAN GAUTHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
825 EASTLAKE AVE E, SEATTLE, WA 98109-4405
(206) 288-6956
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
Primary
TR60984741
WA
207RH0003X
Hematology & Oncology Physician
TR60984741
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174920953
—
WA
Enumeration date
11/22/2014
Last updated
09/04/2020
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