Provider Demographics
NPI: | 1184627564 |
---|---|
Name: | RITCHIE, WILLIAM JAMES (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | WILLIAM |
Middle Name: | JAMES |
Last Name: | RITCHIE |
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: | 12040 NE 128TH ST # 69 |
Mailing Address - Street 2: | |
Mailing Address - City: | KIRKLAND |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98034-3013 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 425-899-3455 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 12040 NE 128TH ST # 69 |
Practice Address - Street 2: | |
Practice Address - City: | KIRKLAND |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98034-3013 |
Practice Address - Country: | US |
Practice Address - Phone: | 425-899-3455 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-05-31 |
Last Update Date: | 2018-11-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | MD60636225 | 207L00000X |
NM | 2003-0470 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 797813 | Medicaid | |
WA | 1184627564 | Medicaid | |
NM | 80926 | Medicaid | |
NM | 925207 | Other | PRONET / AETNA |
NM | 30576555 | Medicaid | |
NM | NM009L48 | Other | BLUE CROSS BLUE SHEILD |
AZ | 797813 | Medicaid |