Basic Information
| Provider Information | |||||||||
| NPI: | 1568410041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERRILLI | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1708 YAKIMA AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984055309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533638700 | ||||||||
| FaxNumber: | 3608256536 | ||||||||
| Practice Location | |||||||||
| Address1: | 1708 YAKIMA AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984055309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533638700 | ||||||||
| FaxNumber: | 3608256536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00046021 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | MD00046021 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | MD00046021 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207LC0200X | MD00046021 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1013366 | 05 | WA | MEDICAID | P00351336 | 01 | WA | RAILROAD MEDICARE | OTHER |