Healthcare Provider Details

I. General information

NPI: 1790772911
Provider Name (Legal Business Name): JOHN FULLERTON BARRETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 1ST AVE N
ILWACO WA
98624-9137
US

IV. Provider business mailing address

174 1ST AVE N
ILWACO WA
98624-9137
US

V. Phone/Fax

Practice location:
  • Phone: 360-642-3181
  • Fax: 360-642-6329
Mailing address:
  • Phone: 360-642-3181
  • Fax: 360-642-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.MD.70159147
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.MD.70159147
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: