Provider Demographics
NPI:1659323087
Name:ADDISON, JOHN HAMILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAMILTON
Last Name:ADDISON
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:PO BOX 1526
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-1526
Mailing Address - Country:US
Mailing Address - Phone:206-275-3588
Mailing Address - Fax:206-275-2073
Practice Address - Street 1:9725 SE 36TH ST STE 214
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3840
Practice Address - Country:US
Practice Address - Phone:206-275-3588
Practice Address - Fax:206-275-2073
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018359207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0186507Medicaid
WAGAB33254Medicare ID - Type Unspecified
WAA03949Medicare UPIN