Provider Demographics
NPI:1821136086
Name:PEPKA, JAMES P (D O)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:PEPKA
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4262
Mailing Address - Country:US
Mailing Address - Phone:360-739-4020
Mailing Address - Fax:253-804-9757
Practice Address - Street 1:3830 A ST SE STE 204
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-8611
Practice Address - Country:US
Practice Address - Phone:253-804-9190
Practice Address - Fax:253-804-5797
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E67937Medicare UPIN