Basic Information
| Provider Information | |||||||||
| NPI: | 1821047747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROCKWELL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | CLYDE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50150 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980150150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252285228 | ||||||||
| FaxNumber: | 4252285733 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 BOREN AVE | ||||||||
| Address2: | STE 1530 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981043560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066243561 | ||||||||
| FaxNumber: | 2066243655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 01/31/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 22946 | WA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | MD27823 | 05 | AK | MEDICAID | 1057124 | 05 | WA | MEDICAID |