Healthcare Provider Details

I. General information

NPI: 1356501803
Provider Name (Legal Business Name): JAMES BERRY RVT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6009 LANHAM PL SW
SEATTLE WA
98126-2973
US

IV. Provider business mailing address

6009 LANHAM PL SW
SEATTLE WA
98126-2973
US

V. Phone/Fax

Practice location:
  • Phone: 206-931-6969
  • Fax:
Mailing address:
  • Phone: 206-931-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: