Provider Demographics
NPI:1447283866
Name:HAM, JAY (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:HAM
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0189
Mailing Address - Country:US
Mailing Address - Phone:360-678-4071
Mailing Address - Fax:360-678-6014
Practice Address - Street 1:1211 24TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2557
Practice Address - Country:US
Practice Address - Phone:360-293-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022934207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5085HAOtherREGENCE BLUE SHIELD
WA0090258OtherDEPT LABOR INDUSTRIES
WA003319001OtherGROUP HEALTH
WA050004992OtherRAILROAD MEDICARE
WA1002740Medicaid
WAG8891556Medicare PIN
WA050004992OtherRAILROAD MEDICARE