Healthcare Provider Details

I. General information

NPI: 1336020395
Provider Name (Legal Business Name): RHEUMATOLOGY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N 5TH AVE STE 3B
SEQUIM WA
98382-3066
US

IV. Provider business mailing address

PO BOX 2742
PORT ANGELES WA
98362-0332
US

V. Phone/Fax

Practice location:
  • Phone: 360-649-2012
  • Fax: 360-251-0291
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LARRY BALENTINE
Title or Position: OWNER
Credential: MD
Phone: 360-649-2012