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1013930197 NPI number — SANDRA LEE GAILEY MD

NPI Number: 1013930197
Health Care Provider/Practitioner: SANDRA LEE GAILEY MD

Information about “1013930197” NPI (SANDRA LEE GAILEY MD) exists in 1013930197 in HTML format HTML  |  1013930197 in plain Text format TXT  |  1013930197 in PDF (Portable Document Format) PDF  |  1013930197 in an XML format XML  formats.

NPI Number : 1013930197 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1013930197",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GAILEY",
    "FirstName": "SANDRA",
    "MiddleName": "LEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "VEDVICK",
    "OtherFirstName": "SANDRA",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1400 E KINCAID ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOUNT VERNON",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98274-4127",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "901 S 5TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MOUNT VERNON",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98274-3942",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-428-6434",
    "PracticeLocationAddressFaxNumber": "360-848-4547",
    "EnumerationDate": "07/26/2006",
    "LastUpdateDate": "02/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "5591",
          "LicenseNumberStateCode": "AK",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "MD60224794",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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