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General NPI Number Information
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NPI Number | 1134184047
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Entity Type | Individual
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Provider Name | JOHN P. HACKETT M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1605 116TH AVE NE STE 102
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City | BELLEVUE
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State | WA
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Zip | 98004-3034
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Country | US
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Telephone | 425-456-0709
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Fax | 425-456-0358
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Provider Business Mailing Address
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Address Line | 1605 116TH AVE NE STE 102
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City | BELLEVUE
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State | WA
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Zip | 98004-3034
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Country | US
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Telephone | 425-456-0709
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Fax | 425-456-0358
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD00013897
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License Number State | WA
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