Provider Demographics
NPI:1912933375
Name:BANZER, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:BANZER
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 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2011 NW MYHRE PL
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8561
Practice Address - Country:US
Practice Address - Phone:360-830-1601
Practice Address - Fax:360-830-1696
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044888207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA193177OtherLABOR & INDUSTRIES
3867363OtherAETNA
7533BAOtherREGENCE BLUESHIELD
WA8424863Medicaid
P00245670OtherRAILROAD MEDICARE
P00245670OtherRAILROAD MEDICARE
G8871085Medicare PIN
WAG8858303Medicare PIN
BB8055697OtherDEA
WA193177OtherLABOR & INDUSTRIES
WA8424863Medicaid
WAG8854913Medicare PIN
3867363OtherAETNA