Provider Demographics
NPI:1770598112
Name:VERZOSA, JUDE GERARD D (MD)
Entity type:Individual
Prefix:
First Name:JUDE GERARD
Middle Name:D
Last Name:VERZOSA
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 1:3021 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2369
Mailing Address - Country:US
Mailing Address - Phone:360-825-6511
Mailing Address - Fax:253-274-7993
Practice Address - Street 1:3021 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2369
Practice Address - Country:US
Practice Address - Phone:360-825-6511
Practice Address - Fax:253-274-7993
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042893207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0194113OtherSTATE L&I
WA1045610Medicaid
WA8904491OtherSTATE CRIME VICTIMS
WA8939176OtherSTATE CRIME VICTIMS
WA0184016OtherSTATE L&I
WAP00143183OtherMEDICARE RAILROAD
WAP00143183OtherMEDICARE RAILROAD
WA0194113OtherSTATE L&I
WA8904491OtherSTATE CRIME VICTIMS
WAI06531Medicare UPIN