Individual
JEROME T JEROME III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
817 COMMERCIAL ST, LEAVENWORTH, WA 98826-1316
(509) 548-3431
(509) 548-2510
Mailing address
817 COMMERCIAL STREET, LEAVENWORTH, WA 98826-1316
(509) 548-3431
(509) 548-2510
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD00036567
WA
207Q00000X
Family Medicine Physician
Primary
MD00036567
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260172
DEPARTMENT OF LABOR & INDUSTRIES
WA
01
—
456484
DEPARTMENT OF LABOR & INDUSTRIES
WA
05
—
8240475
—
WA
05
—
G8894617
—
WA
Enumeration date
08/05/2006
Last updated
11/07/2022
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