Provider Demographics
NPI:1023024270
Name:PIATT, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:PIATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12005 MERIDIAN E STE 101
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3423
Mailing Address - Country:US
Mailing Address - Phone:253-215-1095
Mailing Address - Fax:253-215-1096
Practice Address - Street 1:12005 MERIDIAN E STE 101
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3423
Practice Address - Country:US
Practice Address - Phone:253-215-1095
Practice Address - Fax:253-215-1096
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00044826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1000510Medicaid
WA01161940OtherRAILROAD MEDICARE
WAH11724OtherUPIN
WA0290459OtherWA STATE L&I