Provider Demographics
NPI:1164496097
Name:PIERRE-JEROME, FRANTZ (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANTZ
Middle Name:
Last Name:PIERRE-JEROME
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036940174400000X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No174400000XOther Service ProvidersSpecialist
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA350496OtherL&I-RADIA KING COUNTY
WA350495OtherL&I-RADIA REST OF WA
WAPI6814OtherREGENCE
300091837OtherRAILROAD MEDICARE
WA8237224Medicaid
WA125089OtherL&I
WA1003910Medicaid
WA8922739OtherCRIME VICTIMS
2263382OtherAETNA
WAG8948566Medicare PIN
2263382OtherAETNA
WA350495OtherL&I-RADIA REST OF WA
WAPI6814OtherREGENCE
WAP01592329Medicare PIN