Provider Demographics
NPI:1821047747
Name:ROCKWELL, JAMES CLYDE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLYDE
Last Name:ROCKWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 50150
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98015-0150
Mailing Address - Country:US
Mailing Address - Phone:425-228-5228
Mailing Address - Fax:425-228-5733
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:STE 1530
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3560
Practice Address - Country:US
Practice Address - Phone:206-624-3561
Practice Address - Fax:206-624-3655
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA22946207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD27823Medicaid
WA1057124Medicaid
AKMD27823Medicaid
WAE53752Medicare UPIN