Provider Demographics
NPI:1720024490
Name:MIDTLING, JOHN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:MIDTLING
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 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:8299 161ST AVE NE
Practice Address - Street 2:#101
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3860
Practice Address - Country:US
Practice Address - Phone:425-881-8813
Practice Address - Fax:425-869-7201
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37234207Q00000X
WAMD60139996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38128OtherTLC
TN626001636OtherUNITED HEALTHCARE
TN626001636OtherUSA MANAGED CARE
TN626001636OtherHEALTH PARTNERS
TN3818686Medicaid
TN4135399OtherBLUE CROSS BLUE SHIELD
TN190944OtherUNISON
TN2504635OtherCIGNA
TN626001636OtherUNITED HEALTHCARE
WAG8893267Medicare PIN
TN38128OtherTLC
TN626001636OtherUSA MANAGED CARE
TN3818686Medicaid