Healthcare Provider Details

I. General information

NPI: 1306875083
Provider Name (Legal Business Name): JABI ELIJAH SHRIKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 ENSIGN ROAD NE
OLYMPIA WA
98506-5075
US

IV. Provider business mailing address

3417 ENSIGN ROAD NE
OLYMPIA WA
98506-5075
US

V. Phone/Fax

Practice location:
  • Phone: 360-493-4609
  • Fax: 360-493-4603
Mailing address:
  • Phone: 360-493-4609
  • Fax: 360-493-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD60179553
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: