Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A97899 | CA |
Y | 207X00000X | Orthopaedic Surgeon | MD60007110 | WA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD60007110 | WA |
NPI | 1114022969 |
---|---|
Provider Name | Dr. Jamie R Antoine |
First Address | Kirkland, WA 98034-3048 |
Second Address | Kirkland, WA 98034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 13/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1090846 | (05) | WA |