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

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• J Semmes Mickelwait, MD

  • Dermatology Physician
  • Mount Vernon, WA
  • NPI 1811944309

  Dermatology

  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
• Integrated Rehabilitation Group, PC
• 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

• All providers in Mount Vernon, WA
• 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.