Provider Demographics
NPI:1578762985
Name:JENNIFER L. MCAFEE MD PS
Entity Type:Organization
Organization Name:JENNIFER L. MCAFEE MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER L
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-671-6560
Mailing Address - Street 1:1100 LARRABEE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7341
Mailing Address - Country:US
Mailing Address - Phone:360-371-6560
Mailing Address - Fax:360-671-8820
Practice Address - Street 1:1100 LARRABEE AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7341
Practice Address - Country:US
Practice Address - Phone:360-371-6560
Practice Address - Fax:360-671-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019107207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1771609Medicaid
WA1771609Medicaid