Provider Demographics
NPI:1568410041
Name:VERRILLI, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:VERRILLI
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 1:2420 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2845
Mailing Address - Country:US
Mailing Address - Phone:253-426-4000
Mailing Address - Fax:253-428-8440
Practice Address - Street 1:2420 S STATE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2845
Practice Address - Country:US
Practice Address - Phone:253-426-4000
Practice Address - Fax:253-428-8440
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046021207RC0200X, 207RP1001X, 207RP1001X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00351336OtherRAILROAD MEDICARE
WA1013366Medicaid
WA8447369Medicaid
WAI53008Medicare UPIN
WAG8860656-KING COMedicare PIN