RANDALL W IDEKER P.A. NPI 1538224753

NPI Information

NPI: 1538224753
Provider Name: RANDALL W IDEKER, P.A.
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Address:
2930 MAPLE ST
EVERETT, WA
ZIP 98201
Phone: (425) 261-1500
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Randall W Ideker, P.A. is a medical physician assistant in Everett, WA. Randall W Ideker, P.A. NPI is 1538224753. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2930 MAPLE ST
EVERETT, WA
ZIP 98201-832
Phone: (425) 261-1500

The enumeration date for this NPI number is 12/27/2006 and was last updated on 5/8/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA10000364	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	P15847	MEDICARE UPIN	WASHINGTON
2	G8871788	MEDICARE PIN	WASHINGTON
3	GAB17653	MEDICARE PIN	WASHINGTON
4	8343139	MEDICAID	WASHINGTON
5	G8872389	MEDICARE PIN	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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