Basic Information
| Provider Information | |||||||||
| NPI: | 1023024270 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIATT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DAVID | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12005 MERIDIAN E STE 101 | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983733423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532151095 | ||||||||
| FaxNumber: | 2532151096 | ||||||||
| Practice Location | |||||||||
| Address1: | 12005 MERIDIAN E STE 101 | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983733423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532151095 | ||||||||
| FaxNumber: | 2532151096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 11/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00044826 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1000510 | 05 | WA | MEDICAID | 01161940 | 01 | WA | RAILROAD MEDICARE | OTHER | H11724 | 01 | WA | UPIN | OTHER | 0290459 | 01 | WA | WA STATE L&I | OTHER |