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General NPI Number Information
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NPI Number | 1114950375
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Entity Type | Organization
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Legal Business Name | J SEMMES MICKELWAIT MD PS
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1420 ROOSEVELT AVE SUITE 7
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City | MOUNT VERNON
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State | WA
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Zip | 98273-2687
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Country | US
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Telephone | 360-424-4186
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Fax | 360-428-0927
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Provider Business Mailing Address
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Address Line | 1420 ROOSEVELT AVE SUITE 7
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City | MOUNT VERNON
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State | WA
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Zip | 98273-2687
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Country | US
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Telephone | 360-424-4186
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Fax | 360-428-0927
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Authorized Official
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Title or Position | OWNER
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Name | J SEMMES MICKELWAIT
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Credential | MD
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Telephone | 360-424-4186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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