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General NPI Number Information
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NPI Number | 1851357008
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Entity Type | Organization
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Legal Business Name | LEYTON ENDICOTT JUMP
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 273 SUSSEX AVE E
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City | TENINO
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State | WA
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Zip | 98589-9359
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Country | US
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Telephone | 360-264-5665
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Fax | 360-264-5666
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Provider Business Mailing Address
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Address Line | PO BOX 4020
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City | TENINO
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State | WA
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Zip | 98589-4020
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Country | US
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Telephone | 360-264-5665
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Fax | 360-264-5666
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEYTON ENDICOTT JUMP
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Credential | MD
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Telephone | 360-264-5665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00022762
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License Number State | WA
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