Provider Demographics
NPI:1033207824
Name:BAUSHER, JOHN C (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:BAUSHER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1020 ANDERSON DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1055
Mailing Address - Country:US
Mailing Address - Phone:360-533-6063
Mailing Address - Fax:360-533-2204
Practice Address - Street 1:1020 ANDERSON DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1055
Practice Address - Country:US
Practice Address - Phone:360-533-6063
Practice Address - Fax:360-533-2204
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00017464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1097419Medicaid
E27427Medicare UPIN