1790840965 NPI number — JONATHAN L RITSON MD

Table of content: JONATHAN L RITSON MD (NPI 1790840965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790840965 NPI number — JONATHAN L RITSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RITSON
Provider First Name:
JONATHAN
Provider Middle Name:
L
Provider Name Prefix Text:
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:
1790840965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2601 JAHN AVE NW STE A7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-8900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-514-6547
Provider Business Mailing Address Fax Number:
253-514-8631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 NORTH 30TH STREET
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-779-5858
Provider Business Practice Location Address Fax Number:
253-779-5757
Provider Enumeration Date:
12/27/2006

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: 208100000X , with the licence number:  MD00024441 , 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: 1316246234 . This is a "NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1087121 . This is a "IDSHS" identifier . This identifiers is of the category "OTHER".




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