Provider Demographics
NPI:1124046180
Name:J M CAIN MD PLLC
Entity Type:Organization
Organization Name:J M CAIN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-452-6808
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0235
Mailing Address - Country:US
Mailing Address - Phone:360-452-6808
Mailing Address - Fax:360-417-0127
Practice Address - Street 1:1021 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3901
Practice Address - Country:US
Practice Address - Phone:360-452-6808
Practice Address - Fax:360-417-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045575174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00045575OtherLICENSE NUMBER