Provider Demographics
NPI:1588817233
Name:ESPINOSA, EVERARD JIMENEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:EVERARD
Middle Name:JIMENEZ
Last Name:ESPINOSA
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 1:911-12TH AVE. NORTH
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020
Mailing Address - Country:US
Mailing Address - Phone:425-712-8084
Mailing Address - Fax:425-744-5635
Practice Address - Street 1:911-12TH AVE. NORTH
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020
Practice Address - Country:US
Practice Address - Phone:425-712-8084
Practice Address - Fax:425-744-5635
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00006043207L00000X
WAM.D.00006043207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA35739OtherL&I
WA108-7634Medicaid
ES1987OtherBC RIDER
217000076Medicare PIN
WA35739OtherL&I