Healthcare Provider Details

I. General information

NPI: 1700864261
Provider Name (Legal Business Name): JOHN R. OVERBECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 55TH AVE S
SEATTLE WA
98118-1518
US

IV. Provider business mailing address

4803 55TH AVE S
SEATTLE WA
98118-1518
US

V. Phone/Fax

Practice location:
  • Phone: 206-579-8871
  • Fax:
Mailing address:
  • Phone: 206-579-8871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number24396
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMD00035253
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD455386
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD00035253
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberMD00035253
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: