Basic Information
| Provider Information | |||||||||
| NPI: | 1942210653 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIFENBERY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | DALE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1802 SO. YAKIMA AVE | ||||||||
| Address2: | #202 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535727120 | ||||||||
| FaxNumber: | 2535721071 | ||||||||
| Practice Location | |||||||||
| Address1: | 1802 SO. YAKIMA AVE | ||||||||
| Address2: | #202 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535727120 | ||||||||
| FaxNumber: | 2535721071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD00021615 | WA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0103427 | 01 | WA | L&I | OTHER | 1093863 | 05 | WA | MEDICAID | RI5641 | 01 | WA | REGENCE | OTHER |