Individual
ALAN K MIRLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2525 NE 139TH ST STE 220, VANCOUVER, WA 98686-2719
(360) 882-2778
(360) 604-1616
Mailing address
PO BOX 4825, PORTLAND, OR 97208-4825
(360) 882-2778
(360) 604-1771
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-558
ID
363A00000X
Physician Assistant
Primary
PA60997082
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2143194
—
WA
05
—
807225300
—
ID
01
—
PAWV4
BLUE CROSS
ID
Enumeration date
09/19/2005
Last updated
12/09/2019
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