Provider Demographics
NPI:1972872885
Name:ANNEST, LON S (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:LON
Middle Name:S
Last Name:ANNEST
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2423 NO. 31ST STREET
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-6401
Mailing Address - Country:US
Mailing Address - Phone:253-279-0281
Mailing Address - Fax:646-641-4010
Practice Address - Street 1:2101 FREDERICK DOUGLASS BLVD
Practice Address - Street 2:10B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3469
Practice Address - Country:US
Practice Address - Phone:253-279-0281
Practice Address - Fax:646-649-4010
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA14851208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)