Provider Demographics
NPI:1538340880
Name:LIBMAN, JAMIE (MD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LIBMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MADISON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1306
Mailing Address - Country:US
Mailing Address - Phone:206-505-1000
Mailing Address - Fax:
Practice Address - Street 1:1101 MADISON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1306
Practice Address - Country:US
Practice Address - Phone:206-505-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048331208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0227546OtherL&I
WA8946170OtherL&I CRIME VICTIMS
WA8499790Medicaid
WA8499790Medicaid
WA8869458Medicare PIN