Healthcare Provider Details

I. General information

NPI: 1356321129
Provider Name (Legal Business Name): JOHN L BASTIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAND POINT WAY NE #100
SEATTLE WA
98105-3900
US

IV. Provider business mailing address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-8450
  • Fax: 206-987-8484
Mailing address:
  • Phone: 206-987-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number041046
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD00041128
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00041128
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: