Provider Demographics
NPI:1376572214
Name:BUTTITTA, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BUTTITTA
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:PO BOX 13310
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:WA
Mailing Address - Zip Code:98013-0310
Mailing Address - Country:US
Mailing Address - Phone:206-212-0977
Mailing Address - Fax:206-420-1458
Practice Address - Street 1:1818 S UNION AVE STE 1A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1953
Practice Address - Country:US
Practice Address - Phone:206-212-0977
Practice Address - Fax:206-420-1458
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG49224Medicare UPIN