Individual
DR. JEREMY A IDJADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
834 SHERIDAN ST, PORT TOWNSEND, WA 98368-2443
(360) 344-0400
(360) 344-0418
Mailing address
834 SHERIDAN ST, PORT TOWNSEND, WA 98368-2443
(360) 385-2200
(360) 344-0418
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD00046591
WA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD00046591
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0213802
L & I
WA
01
—
G8862908
MEDICARE POSM
WA
01
—
G8891350
MEDICARE EMRI
WA
01
—
P00669277
MEDICARE RR KING CO.
WA
Enumeration date
10/04/2006
Last updated
06/08/2021
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