Provider Demographics
NPI:1407862279
Name:BEARD, JOHN WALKER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALKER
Last Name:BEARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1229 MADISON ST STE 1440
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3538
Mailing Address - Country:US
Mailing Address - Phone:206-625-0578
Mailing Address - Fax:206-625-9184
Practice Address - Street 1:1229 MADISON ST STE 1440
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3538
Practice Address - Country:US
Practice Address - Phone:206-625-0578
Practice Address - Fax:206-625-9184
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60337570207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G08935Medicare UPIN