Provider Demographics
NPI:1275541393
Name:SEABROOK, JONATHAN JR (PAC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:SEABROOK
Suffix:JR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-339-5422
Mailing Address - Fax:425-339-5444
Practice Address - Street 1:4027 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4920
Practice Address - Country:US
Practice Address - Phone:425-304-8476
Practice Address - Fax:425-304-8477
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA210947OtherLABOR AND INDUSTRIES
WAG8878562Medicare PIN