Provider Demographics
NPI:1366496697
Name:JEX, JAMES P (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:JEX
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 1:118 N. WHITCOMB AVE
Mailing Address - Street 2:C/O: CREDENTIALING
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-2053
Mailing Address - Country:US
Mailing Address - Phone:509-486-3191
Mailing Address - Fax:509-486-3176
Practice Address - Street 1:118 S WHITCOMB AVE
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-9287
Practice Address - Country:US
Practice Address - Phone:509-486-3191
Practice Address - Fax:509-486-4204
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61071879208600000X, 208D00000X, 208600000X, 208D00000X, 208D00000X
NM2002-0381208600000X, 208600000X
MT33767208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2162615Medicaid
NML1251Medicaid