Healthcare Provider Details

I. General information

NPI: 1821047747
Provider Name (Legal Business Name): JAMES CLYDE ROCKWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BOREN AVE STE 1530
SEATTLE WA
98104-3560
US

IV. Provider business mailing address

PO BOX 50150
BELLEVUE WA
98015-0150
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-3561
  • Fax: 206-624-3655
Mailing address:
  • Phone: 425-228-5228
  • Fax: 425-228-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number22946
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: