Basic Information
Provider Information | |||||||||
NPI: | 1467542233 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LAURINO | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | ALLEN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD, MPH | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LAURINE | ||||||||
OtherFirstName: | JAMES | ||||||||
OtherMiddleName: | ALLEN | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1400 E KINCAID ST | ||||||||
Address2: | ATTN: CREDENTIALING | ||||||||
City: | MOUNT VERNON | ||||||||
State: | WA | ||||||||
PostalCode: | 982744127 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3604282500 | ||||||||
FaxNumber: | 3604286485 | ||||||||
Practice Location | |||||||||
Address1: | 3823 - 172ND STREET NE | ||||||||
Address2: | CASCADE SKAGIT HEALTH ALLIANCE | ||||||||
City: | ARLINGTON | ||||||||
State: | WA | ||||||||
PostalCode: | 98223 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3606185000 | ||||||||
FaxNumber: | 3606599834 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/13/2006 | ||||||||
LastUpdateDate: | 06/04/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 30138 | WI | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 2083X0100X | MD00024695 | WA | Y |   | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.