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NPI Code Detail

MEDICARE: DR. JAMES IVAN MAEDA M.D.

MEDICARE: DR. JAMES IVAN MAEDA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD60069028WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538162854
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES IVAN MAEDA M.D.
Provider Business Mailing Address
First Line : PO BOX 793
Second Line :
City : OMAK
State : WA
Zip : 98841-0793
Country : US
Telephone Number : 509-826-7635
Fax Number : 509-826-7211
Provider Business Practice Location Address
First Line : 529 JASMINE ST
Second Line :
City : OMAK
State : WA
Zip : 98841-9589
Country : US
Telephone Number : 509-826-1600
Fax Number : 509-826-3633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 11/20/2017

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