Provider Demographics
NPI:1811934425
Name:RIEKE, JOHN WHITELAW (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WHITELAW
Last Name:RIEKE
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 1:5001 88TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4643
Mailing Address - Country:US
Mailing Address - Phone:206-920-3469
Mailing Address - Fax:
Practice Address - Street 1:5001 88TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-4643
Practice Address - Country:US
Practice Address - Phone:206-920-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-144702085R0001X
WAMD000245222085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8304453Medicaid
A06459Medicare UPIN