Healthcare Provider Details

I. General information

NPI: 1063624104
Provider Name (Legal Business Name): JOHN ALLAN ERNST PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST # MS 02-12 ST JOSEPH MEDICAL CENTER
TACOMA WA
98405-4933
US

IV. Provider business mailing address

1717 S J ST # MS 02-12 PO BOX 2197, ST JOSEPH MEDICAL CENTER
TACOMA WA
98405-4933
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6762
  • Fax: 253-426-6224
Mailing address:
  • Phone: 253-426-6762
  • Fax: 253-426-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number953
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: