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General NPI Number Information
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NPI Number | 1659440543
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Entity Type | Individual
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Provider Name | JERRY JOHN MD
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 1901 S CEDAR ST STE 101
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City | TACOMA
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State | WA
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Zip | 98405-2302
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Country | US
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Telephone | 253-301-5370
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Fax | 253-301-5379
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Provider Business Mailing Address
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Address Line | PO BOX 5299 MS: 820-5-PCO
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City | TACOMA
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State | WA
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Zip | 98415-0299
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Country | US
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Telephone |
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Fax |
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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 | 207RA0001X
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Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
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License Number | 0101274896
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RA0001X
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Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
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License Number | MD61593680
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 200501438
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 5210479-1205
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License Number State | UT
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