Provider Demographics
NPI:1821108713
Name:GILLETTE, JIMY E (MD)
Entity Type:Individual
Prefix:
First Name:JIMY
Middle Name:E
Last Name:GILLETTE
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 1:1100 OLIVE WAY MSC M4-PA
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19116 33RD AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4706
Practice Address - Country:US
Practice Address - Phone:425-771-7500
Practice Address - Fax:425-712-7903
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8390767Medicaid
WA0039581OtherLABOR & INDUSTRY
WA6914GIOtherBLUE SHIELD
WAUS7405495OtherAETNA/USHC SPECIALIST
G72079Medicare UPIN
WA8390767Medicaid
WA8801296Medicare PIN