Healthcare Provider Details

I. General information

NPI: 1568692705
Provider Name (Legal Business Name): NOEUD DE PAPILLON LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 LAWRENCE ST
PORT TOWNSEND WA
98368-6529
US

IV. Provider business mailing address

1334 LAWRENCE ST
PORT TOWNSEND WA
98368-6529
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-4843
  • Fax:
Mailing address:
  • Phone: 360-385-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD00019338
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD00019338
License Number StateWA

VIII. Authorized Official

Name: DR. JAMES KIMBER ROTCHFORD
Title or Position: OWNER/PHYSICIAN
Credential: MD,MPH, FAAMA
Phone: 360-385-4843