J Semmes Mickelwait, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD00013676 Issued in WA

Practice address

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

Phone

(360) 424-4186

Fax

(360) 428-0927

NPI assigned

May 28, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• J Semmes Mickelwait MD PS

  • Dermatology Physician
  • Mount Vernon, WA
  • NPI 1114950375
  NPD (past) Authorized official

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811944309",
    "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": {
        "last_name": "MICKELWAIT",
        "first_name": "J",
        "middle_name": "SEMMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "MD00013676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124502",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anita Marie Meyer, MD
• Erin Meyer, RN
• James Lloyd Meyers, B.A.
• Michele K. Coleman DO & Associates, Inc.
• Mickelwait Family Dentistry PLLC
• Morghan B Milagrosa, CNM, ANP
• Denise Lee Miller
• Jacob Darris Miller, B.A.
• Jeffrey Wells Miller, MD
• Kimberly Kae Miller, MPT

• 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 Jul 8, 2007; 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.