Provider Demographics
NPI:1942210653
Name:RIFENBERY, JAMES DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DALE
Last Name:RIFENBERY
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 1:1802 SO. YAKIMA AVE
Mailing Address - Street 2:#202
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-572-7120
Mailing Address - Fax:253-572-1071
Practice Address - Street 1:1802 SO. YAKIMA AVE
Practice Address - Street 2:#202
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-572-7120
Practice Address - Fax:253-572-1071
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021615208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0103427OtherL&I
WA1093863Medicaid
WARI5641OtherREGENCE
WARI5641OtherREGENCE
WA1093863Medicaid