Provider Demographics
NPI:1356321129
Name:BASTIEN, JOHN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:BASTIEN
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 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-8450
Mailing Address - Fax:
Practice Address - Street 1:4500 SAND POINT WAY NE
Practice Address - Street 2:#100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3900
Practice Address - Country:US
Practice Address - Phone:206-987-8450
Practice Address - Fax:206-987-8484
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041046171000000X
WAMD00041128207LP3000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No171000000XOther Service ProvidersMilitary Health Care Provider
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology