J Semmes Mickelwait MD PS

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

J SEMMES MICKELWAIT MD PS

Practice address

1420 Roosevelt Ave
Suite 7
Mount Vernon, WA 98273-2687

Phone

(360) 424-4186

Fax

(360) 428-0927

NPI assigned

Jul 9, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

J Semmes Mickelwait, MDNPI 1811944309

Title

Owner

Phone

(360) 424-4186

Specialties & licenses 1

Addresses

Other names 1

• Advanced Dermatology and Skin Renewal Center Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• J Semmes Mickelwait, MD

  • Dermatology Physician
  • Mount Vernon, WA
  • NPI 1811944309
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114950375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 ROOSEVELT AVE",
            "address_2": "SUITE 7",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732687",
            "telephone_number": "360-424-4186",
            "fax_number": "360-428-0927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 ROOSEVELT AVE",
            "address_2": "SUITE 7",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732687",
            "telephone_number": "360-424-4186",
            "fax_number": "360-428-0927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J SEMMES MICKELWAIT MD PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MICKELWAIT",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "SEMMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-424-4186",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology and Skin Renewal Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tara Lynn Ingrum, LMP
• Integrated Rehabilitation Group, PC (Northwest Sport & Spine Physical Therapy- Mount Vernon)
• Integrated Rehabilitation Group, PC (IRG Hand Therapy Mount Vernon)
• Megan M. Irwin, PA-C
• Shimrote Ishaque, PHARMD
• Eric David Jacobs, M.A.
• Robert R Jacobsen, MD
• Douglas Edmund Jacobsmeyer, DC
• Mary Jo Jahn
• Mark Z Jamantoc, PT

• Dermatology Physician in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.