Individual
JAMES BRAD DIESTELHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4545 CORDATA PKWY, BELLINGHAM, WA 98226-7123
(360) 738-2200
(360) 752-5687
Mailing address
PO BOX 5096, BELLINGHAM, WA 98227-5096
(360) 738-2200
(360) 752-5687
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
MD00041071
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0230369
L&I/CRIME VICTIMS
WA
05
—
1336148766
—
WA
01
—
4912DI
REGENCE
WA
01
—
7704353
AETNA
WA
01
—
MD4918W
ALASKA MEDICAID
AK
Enumeration date
07/18/2005
Last updated
09/22/2010
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