Healthcare Provider Details

I. General information

NPI: 1336146836
Provider Name (Legal Business Name): JAMES D. PRICKETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 CORDATA PKWY
BELLINGHAM WA
98226-8037
US

IV. Provider business mailing address

PO BOX 5096
BELLINGHAM WA
98227-5096
US

V. Phone/Fax

Practice location:
  • Phone: 360-738-2200
  • Fax: 360-752-5653
Mailing address:
  • Phone: 360-738-2200
  • Fax: 360-752-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD00026079
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: