Healthcare Provider Details

I. General information

NPI: 1841353711
Provider Name (Legal Business Name): JOHN THOMAS KERRIGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 BRIDGEPORT WAY SW
LAKEWOOD WA
98499-3004
US

IV. Provider business mailing address

1313 BROADWAY SUITE 200
TACOMA WA
98402-3400
US

V. Phone/Fax

Practice location:
  • Phone: 253-985-6403
  • Fax: 253-985-2948
Mailing address:
  • Phone: 253-426-6306
  • Fax: 253-426-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00030834
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: