Provider Demographics
NPI:1730246182
Name:PRESTRIDGE, JAMES G (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:PRESTRIDGE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 COOKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9047
Mailing Address - Country:US
Mailing Address - Phone:360-736-2527
Mailing Address - Fax:
Practice Address - Street 1:1720 COOKS HILL RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9047
Practice Address - Country:US
Practice Address - Phone:360-736-2527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60001369213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1722PROtherREGENCE
WA236866OtherL & I
WA8514374OtherDSHS
WA4409000001OtherDMERC
WA8514374OtherDSHS