Individual
DR. JAYME T. MACKAY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1271 HIGHLAND AVE, SUITE A, CLARKSTON, WA 99403-2846
(509) 751-1500
(509) 751-1504
Mailing address
1271 HIGHLAND AVE, SUITE A, CLARKSTON, WA 99403-2846
(509) 751-1500
(509) 751-1504
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35944
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010001517
REGENCE BLUE SHIELD PROV
ID
05
—
1103514
—
WA
01
—
1139255
IDAHO MEDICARE NUMBER
ID
01
—
120618
DL &I PROV NUMBER
WA
01
—
52092
BLUE CROSS IDAHO
ID
Enumeration date
07/08/2005
Last updated
07/08/2007
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