Provider Demographics
NPI:1487809703
Name:LITVACK, JAMIE R (MD, MS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:R
Last Name:LITVACK
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,MS
Mailing Address - Street 1:1728 W MARINE VIEW DR STE 111
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2094
Mailing Address - Country:US
Mailing Address - Phone:425-259-4041
Mailing Address - Fax:
Practice Address - Street 1:3125 COLBY AVE STE J
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4032
Practice Address - Country:US
Practice Address - Phone:425-791-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60628497207Y00000X
VA0101251480207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1487809703Medicaid
PENDINGMedicare PIN