Provider Demographics
NPI:1295836815
Name:LERAAS, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LERAAS
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 1:8617 MARTIN WAY E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5805
Mailing Address - Country:US
Mailing Address - Phone:360-456-4959
Mailing Address - Fax:360-456-2171
Practice Address - Street 1:8617 MARTIN WAY E
Practice Address - Street 2:SUITE 101
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5805
Practice Address - Country:US
Practice Address - Phone:360-456-4959
Practice Address - Fax:360-456-2171
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00013748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA08738Medicare UPIN