Healthcare Provider Details

I. General information

NPI: 1104032036
Provider Name (Legal Business Name): JOHN PHILIP HOWARD II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOONE RD PEDIATRIC CLINIC
BREMERTON WA
98312-1894
US

IV. Provider business mailing address

1 BOONE RD PEDIATRIC CLINIC
BREMERTON WA
98312-1894
US

V. Phone/Fax

Practice location:
  • Phone: 360-475-4216
  • Fax: 360-475-4912
Mailing address:
  • Phone: 360-475-4216
  • Fax: 360-475-4912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01044073A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: