Provider Demographics
NPI:1669483947
Name:SASHKO, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:SASHKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 BRIDGEPORT WAY SW STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3051
Mailing Address - Country:US
Mailing Address - Phone:253-985-6688
Mailing Address - Fax:253-539-6025
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3051
Practice Address - Country:US
Practice Address - Phone:253-985-6688
Practice Address - Fax:253-539-6025
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0142155OtherSTATE L&I
WA0126505OtherSTATE L&I
WA80138602OtherMEDICARE RAILROAD
WA8194466Medicaid
WA8901653OtherSTATE CRIME VICTIMS
WAP00196556OtherMEDICARE RAILROAD
WA1045158Medicaid
WA8926858OtherSTATE CRIME VICTIMS
WAG8851129Medicare PIN
WA8926858OtherSTATE CRIME VICTIMS
WA8194466Medicaid