Healthcare Provider Details

I. General information

NPI: 1114022969
Provider Name (Legal Business Name): JAMIE R ANTOINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 120TH AVE NE STE H210
KIRKLAND WA
98034
US

IV. Provider business mailing address

12911 120TH AVE NE STE G10
KIRKLAND WA
98034-3048
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-4000
  • Fax: 425-821-3550
Mailing address:
  • Phone: 425-823-4000
  • Fax: 425-821-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD60007110
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD60007110
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: