Basic Information
| Provider Information | |||||||||
| NPI: | 1225209471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | BISCHOFF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34888 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4259774620 | ||||||||
| FaxNumber: | 4257459836 | ||||||||
| Practice Location | |||||||||
| Address1: | 19000 33RD AVE W | ||||||||
| Address2: | STE 230 | ||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980364752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256867138 | ||||||||
| FaxNumber: | 4257454104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 06/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 80848 | AZ | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0102X | MD 60139285 | WA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 2008051 | 05 | WA | MEDICAID | 0317315 | 01 | WA | LABOR AND INDUSTRIES | OTHER |