Provider Demographics
NPI:1467448118
Name:VERRILLI, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:VERRILLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:355 NW RICHMOND BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3101
Mailing Address - Country:US
Mailing Address - Phone:206-546-5181
Mailing Address - Fax:206-546-6575
Practice Address - Street 1:355 NW RICHMOND BEACH RD
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3101
Practice Address - Country:US
Practice Address - Phone:206-546-5181
Practice Address - Fax:206-546-6575
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00014046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110035519OtherRR MEDICARE
A06104Medicare UPIN
WA110035519OtherRR MEDICARE