Provider Demographics
NPI:1265502751
Name:STATES, JAMES HENRY II (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HENRY
Last Name:STATES
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12257
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508
Mailing Address - Country:US
Mailing Address - Phone:360-545-3416
Mailing Address - Fax:206-202-1985
Practice Address - Street 1:561 N TRIBAL CENTER RD
Practice Address - Street 2:
Practice Address - City:SKOKOMISH NATION
Practice Address - State:WA
Practice Address - Zip Code:98584-7416
Practice Address - Country:US
Practice Address - Phone:360-426-5755
Practice Address - Fax:360-877-2032
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00012725207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA07403Medicare UPIN