Basic Information
| Provider Information | |||||||||
| NPI: | 1124046180 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | J M CAIN MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1276 | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983620235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604526808 | ||||||||
| FaxNumber: | 3604170127 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 CAROLINE ST | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983623901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604526808 | ||||||||
| FaxNumber: | 3604174127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 10/03/2007 | ||||||||
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| AuthorizedOfficialLastName: | CAIN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3604526808 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD00045575 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | MD00045575 | 01 | WA | LICENSE NUMBER | OTHER |