Healthcare Provider Details

I. General information

NPI: 1275643181
Provider Name (Legal Business Name): JOHN A. BOKAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY MHC
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

2017 FAIRVIEW AVE E #F
SEATTLE WA
98102-3589
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2007
  • Fax: 206-764-2572
Mailing address:
  • Phone: 206-329-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00016362
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: