Provider Demographics
NPI:1770677007
Name:LINDSTROM, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:LINDSTROM
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 1:1111 W SPRUCE ST
Mailing Address - Street 2:SUITE 32
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3257
Mailing Address - Country:US
Mailing Address - Phone:509-452-8787
Mailing Address - Fax:509-452-6295
Practice Address - Street 1:1111 W SPRUCE ST
Practice Address - Street 2:SUITE 32
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3257
Practice Address - Country:US
Practice Address - Phone:509-452-8787
Practice Address - Fax:509-452-6295
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8104358OtherCHPW
WA8104358Medicaid
911019392OtherCOMMERCIAL
100OtherGROUP HEALTH
WA47612OtherL & I
WALI6635OtherREGENCE
100OtherGROUP HEALTH
WA47612OtherL & I
WA8104358Medicaid