Provider Demographics
NPI:1346412905
Name:JOHN P. HACKETT, MD, P.S.
Entity type:Organization
Organization Name:JOHN P. HACKETT, MD, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-456-0709
Mailing Address - Street 1:1603 116TH AVE NE
Mailing Address - Street 2:STE 112
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3009
Mailing Address - Country:US
Mailing Address - Phone:425-456-0709
Mailing Address - Fax:425-456-0358
Practice Address - Street 1:1603 116TH AVE NE
Practice Address - Street 2:STE 112
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3009
Practice Address - Country:US
Practice Address - Phone:425-456-0709
Practice Address - Fax:425-456-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013897207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty