Healthcare Provider Details

I. General information

NPI: 1477521888
Provider Name (Legal Business Name): JOHN RANDALL REPLOGLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 REID ST ATTN MCHJ QCR MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-1100
US

IV. Provider business mailing address

9040 REID ST ATTN MCHJ QCR MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2252
  • Fax: 253-968-3278
Mailing address:
  • Phone: 253-968-2252
  • Fax: 253-968-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD20360
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: