Provider Demographics
NPI:1841353711
Name:KERRIGAN, JOHN THOMAS (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:KERRIGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1313 BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3400
Mailing Address - Country:US
Mailing Address - Phone:253-426-6306
Mailing Address - Fax:253-426-6344
Practice Address - Street 1:11315 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3004
Practice Address - Country:US
Practice Address - Phone:253-985-6403
Practice Address - Fax:253-985-2948
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2020-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00030834207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA013194010OtherGROUP HEALTH COOPERATIVE
WA911577098-06OtherKITSAP PHYSICIANS SERVICE
WA050028289OtherRAILROAD MEDICARE
050028289OtherRAILROAD MEDICARE
WA911577098OtherPREMEREA BLUE CROSS
WA192575000OtherOWCP
WA911577098OtherUNIFORM MEDICAL PLAN
WA1086214Medicaid
WA0246538OtherSTATE L&I
WA36251OtherLABOR AND INDUSTRIES
WAKE3250OtherREGENCE
WA0246538OtherSTATE L&I
WA911577098OtherUNIFORM MEDICAL PLAN
WAG8879496Medicare PIN