Provider Demographics
NPI:1316948904
Name:PETRIN, JAMES H (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:H
Last Name:PETRIN
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 1:8301 161ST AVE NE STE 108
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3858
Mailing Address - Country:US
Mailing Address - Phone:425-485-7985
Mailing Address - Fax:425-483-2375
Practice Address - Street 1:8301 161ST AVE NE STE 108
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3858
Practice Address - Country:US
Practice Address - Phone:425-485-7985
Practice Address - Fax:425-483-2375
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035810207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA128869OtherDEPT OF L&I
WA7136443Medicaid
WA53030OtherDEPT OF L&I GROUP
WA8228371Medicaid
WA7095656Medicaid
G8866840Medicare PIN
WA128869OtherDEPT OF L&I
WA53030OtherDEPT OF L&I GROUP
WA7095656Medicaid