1316948904 NPI number — MR. JAMES H PETRIN MD

Table of content: MR. JAMES H PETRIN MD (NPI 1316948904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316948904 NPI number — MR. JAMES H PETRIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETRIN
Provider First Name:
JAMES
Provider Middle Name:
H
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316948904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8301 161ST AVE NE STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98052-3858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-485-7985
Provider Business Mailing Address Fax Number:
425-483-2375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8301 161ST AVE NE STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98052-3858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-485-7985
Provider Business Practice Location Address Fax Number:
425-483-2375
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207NS0135X , with the licence number:  MD00035810 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: MD00035810 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 128869 . This is a "DEPT OF L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7136443 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53030 . This is a "DEPT OF L&I GROUP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8228371 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7095656 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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