Provider Demographics
NPI:1154477511
Name:KILWAY, JAMES BERNARD II (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BERNARD
Last Name:KILWAY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8614 E MILL PLAIN BLVD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2059
Mailing Address - Country:US
Mailing Address - Phone:360-254-9991
Mailing Address - Fax:360-254-9997
Practice Address - Street 1:8614 E MILL PLAIN BLVD
Practice Address - Street 2:SUITE #201
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2059
Practice Address - Country:US
Practice Address - Phone:360-254-9991
Practice Address - Fax:360-254-9997
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00040044208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8312324001OtherBLUE CROSS
WA8280695Medicaid
WA8280695Medicaid
WAGAB40036Medicare ID - Type Unspecified