Provider Demographics
NPI:1386770543
Name:PRITCHARD, MICHAEL JOHN (LMP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:PRITCHARD
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 LOST RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MAZAMA
Mailing Address - State:WA
Mailing Address - Zip Code:98833-9734
Mailing Address - Country:US
Mailing Address - Phone:509-996-3960
Mailing Address - Fax:509-997-0697
Practice Address - Street 1:42 LOST RIVER RD
Practice Address - Street 2:
Practice Address - City:MAZAMA
Practice Address - State:WA
Practice Address - Zip Code:98833-9707
Practice Address - Country:US
Practice Address - Phone:509-996-3960
Practice Address - Fax:509-997-0697
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019746174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0178378OtherLABOR&INDUSTRIES