Provider Demographics
NPI:1902804594
Name:MACKAY, JAYME T (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYME
Middle Name:T
Last Name:MACKAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1271 HIGHLAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2846
Mailing Address - Country:US
Mailing Address - Phone:509-751-1500
Mailing Address - Fax:509-751-1504
Practice Address - Street 1:1271 HIGHLAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2846
Practice Address - Country:US
Practice Address - Phone:509-751-1500
Practice Address - Fax:509-751-1504
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA35944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010001517OtherREGENCE BLUE SHIELD PROV
WA1103514Medicaid
WA120618OtherDL &I PROV NUMBER
ID1139255OtherIDAHO MEDICARE NUMBER
ID52092OtherBLUE CROSS IDAHO
WA120618OtherDL &I PROV NUMBER
WAG24649Medicare UPIN