Individual
LEYTON ENDICOTT JUMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
273 SUSSEX AVE E, TENINO, WA 98589-9359
(360) 264-5665
(360) 264-5666
Mailing address
PO BOX 4020, TENINO, WA 98589-4020
(360) 264-5665
(360) 264-5666
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MD00022762
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1005719
—
WA
01
—
101589
BLACK LUNG
—
01
—
90836
LABOR & INDUSTRIES
WA
01
—
G8856183
PTAN
—
01
—
T01236
REGENCE
—
Enumeration date
04/25/2006
Last updated
02/26/2015
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