Healthcare Provider Details

I. General information

NPI: 1245285501
Provider Name (Legal Business Name): JOHN PATRICK MCCLOSKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S J ST STE 102
TACOMA WA
98405-4100
US

IV. Provider business mailing address

603 S J ST STE 102
TACOMA WA
98405-4100
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-4868
  • Fax: 253-396-4870
Mailing address:
  • Phone: 253-396-4868
  • Fax: 253-396-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00022079
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: