NPIMap

Organization Active NPI

NW Dermatology & Skin Cancer Clinic

  • Dermatology Physician
  • Edmonds, WA
National Provider Identifier
1336292796
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
600 551-763 Issued in WA
Legal business name
NW DERMATOLOGY & SKIN CANCER CLINIC
Practice address
21600 Highway 99
Suite 280
Edmonds, WA 98026-8012
Phone
(425) 774-2616
Fax
(425) 774-2660
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Dr. John Lawrence Headley, M.D.
Title
Owner
Phone
(425) 774-2616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 600 551-763 WA Primary

Addresses

Primary practice location

21600 Highway 99
Suite 280
Edmonds, WA 98026-8012

Mailing address

21600 Highway 99
Suite 280
Edmonds, WA 98026-8012
Phone (425) 774-2616

Other names 1

  • NW DERM AND SKIN CANCER CLC Other name

National Provider Directory

National Provider Directory

Locations

21600 Highway 99
Ste 208
Edmonds, WA 98026

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1336292796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21600 HIGHWAY 99",
            "address_2": "SUITE 280",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980268012",
            "telephone_number": "425-774-2616",
            "fax_number": "425-774-2660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21600 HIGHWAY 99",
            "address_2": "SUITE 280",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980268012",
            "telephone_number": "425-774-2616",
            "fax_number": "425-774-2660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NW DERMATOLOGY & SKIN CANCER CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "HEADLEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-774-2616",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "WA",
            "license": "600 551-763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NW DERM AND SKIN CANCER CLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Edmonds, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; 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.