Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
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 Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD455386
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.MD.00035253
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number24396
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: