Provider Demographics
NPI:1942251376
Name:MANNSCHRECK, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:MANNSCHRECK
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 1:1254 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2841
Mailing Address - Country:US
Mailing Address - Phone:509-758-6132
Mailing Address - Fax:509-751-9726
Practice Address - Street 1:1254 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2841
Practice Address - Country:US
Practice Address - Phone:509-758-6132
Practice Address - Fax:509-751-9726
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-62362085R0202X
WAMD000267682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1121334Medicaid
WA72728OtherBLUE CROSS OF IDAHO
WA000010149194OtherREGENCE BLUE SHIELD
WAP00186232OtherRAILROAD MEDICARE
WAP00186232OtherRAILROAD MEDICARE
WA8850705Medicare PIN