Healthcare Provider Details

I. General information

NPI: 1316948904
Provider Name (Legal Business Name): JAMES H PETRIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 161ST AVE NE STE 108
REDMOND WA
98052-3858
US

IV. Provider business mailing address

8301 161ST AVE NE STE 108
REDMOND WA
98052-3858
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-7985
  • Fax: 425-483-2375
Mailing address:
  • Phone: 425-485-7985
  • Fax: 425-483-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD00035810
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD00035810
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: