Healthcare Provider Details

I. General information

NPI: 1982646758
Provider Name (Legal Business Name): JOHN LLOYD ESPINOSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 E KINCAID ST
MOUNT VERNON WA
98274-4126
US

IV. Provider business mailing address

PO BOX 37
MOUNT VERNON WA
98273-0037
US

V. Phone/Fax

Practice location:
  • Phone: 360-428-2211
  • Fax:
Mailing address:
  • Phone: 360-424-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD00010959
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMD00010959
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberMD00010959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: