Provider Demographics
NPI:1023695095
Name:WAMPACH, JOHN JACOB MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:JOHN JACOB
Middle Name:MATTHEW
Last Name:WAMPACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JJ
Other - Middle Name:
Other - Last Name:WAMPACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:1401 MADISON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1316
Mailing Address - Country:US
Mailing Address - Phone:206-386-6197
Mailing Address - Fax:
Practice Address - Street 1:1401 MADISON AVE SUITE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-386-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program