Individual
GEORDIE MCGILL GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1959 NE PACIFIC ST, SEATTLE, WA 98195-0001
(206) 520-5000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10004792
WA
363AM0700X
Medical Physician Assistant
Primary
PA10004792
WA
363AS0400X
Surgical Physician Assistant
PA10004792
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00039587
LABOR AND INDUSTRIES #
WA
01
—
193752
L&I PROVIDER NUMBER
WA
01
—
266643
LNI PROVIDER ID
WA
01
—
4320GL
BLUE SHIELD #
WA
05
—
8418089
—
WA
Enumeration date
01/06/2006
Last updated
08/20/2025
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