MEDICARE: JAMES D. PRICKETT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	MD00026079	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4569PR	OTHER	WA	REGENCE
4	4587359	OTHER	WA	AETNA
5	0229979	OTHER	WA	L&I AND CRIME VICTIMS

General Provider Information

NPI Number	:	1336146836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES D. PRICKETT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5096
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98227-5096
Country	:	US
Telephone Number	:	360-738-2200
Fax Number	:	360-752-5653

Provider Business Practice Location Address
First Line	:	4465 CORDATA PKWY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8037
Country	:	US
Telephone Number	:	360-738-2200
Fax Number	:	360-752-5653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	11/19/2010

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