Individual
DR. JEFFREY E MAPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
117 SPRUCE ST, ILWACO, WA 98624
(360) 642-2662
(360) 642-2663
Mailing address
PO BOX 919, ILWACO, WA 98624-0919
(360) 642-2662
(360) 642-2663
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00035420
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1012MA
BCBS
WA
01
—
178545
L&I
WA
05
—
8319055
—
WA
Enumeration date
10/04/2005
Last updated
07/08/2007
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