Provider Demographics
NPI:1568692705
Name:NOEUD DE PAPILLON LTD
Entity Type:Organization
Organization Name:NOEUD DE PAPILLON LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KIMBER
Authorized Official - Last Name:ROTCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MPH, FAAMA
Authorized Official - Phone:360-385-4843
Mailing Address - Street 1:1334 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6529
Mailing Address - Country:US
Mailing Address - Phone:360-385-4843
Mailing Address - Fax:
Practice Address - Street 1:1334 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6529
Practice Address - Country:US
Practice Address - Phone:360-385-4843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000193382084A0401X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1797406Medicaid
WAG115000042Medicare UPIN