Healthcare Provider Details

I. General information

NPI: 1649326869
Provider Name (Legal Business Name): JAMES M SQUIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5343 TALLMAN AVE NW SUITE 203
SEATTLE WA
98107-3931
US

IV. Provider business mailing address

5343 TALLMAN AVE NW SUITE 203
SEATTLE WA
98107-3931
US

V. Phone/Fax

Practice location:
  • Phone: 206-789-5555
  • Fax:
Mailing address:
  • Phone: 206-789-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM000018087
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: