Healthcare Provider Details

I. General information

NPI: 1104092758
Provider Name (Legal Business Name): RAYMOND WILLIAM WEINRICH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S 13TH ST STE 300
MOUNT VERNON WA
98274-4100
US

IV. Provider business mailing address

1400 E KINCAID ST
MOUNT VERNON WA
98274-4127
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-9757
  • Fax: 360-814-5267
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number106
License Number StateMP
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA61021806
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: