Provider Demographics
NPI:1114022969
Name:ANTOINE, JAMIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:R
Last Name:ANTOINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 120TH AVE NE STE G10
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3048
Mailing Address - Country:US
Mailing Address - Phone:425-823-4000
Mailing Address - Fax:425-821-3550
Practice Address - Street 1:12911 120TH AVE NE STE H210
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-823-4000
Practice Address - Fax:425-821-3550
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60007110207XX0005X, 207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1090846Medicaid