Healthcare Provider Details

I. General information

NPI: 1336125715
Provider Name (Legal Business Name): JODY M BOCKRATH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODY M WEINSTEIN MD

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 W. MARINE VIEW DRIVE #C NORTH SOUND EMERGENCY MEDICINE
EVERETT WA
98201
US

IV. Provider business mailing address

27101 SE 166TH PL
ISSAQUAH WA
98027-6911
US

V. Phone/Fax

Practice location:
  • Phone: 425-259-0212
  • Fax:
Mailing address:
  • Phone: 360-202-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number62665
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD 60141982
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number00025558
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: