Provider Demographics
NPI:1538665542
Name:FONKEN, ISAAC ANTON (MD)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:ANTON
Last Name:FONKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4040
Mailing Address - Country:US
Mailing Address - Phone:253-792-6680
Mailing Address - Fax:253-403-2915
Practice Address - Street 1:1112 6TH AVE
Practice Address - Street 2:3-TFM
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4040
Practice Address - Country:US
Practice Address - Phone:253-792-6680
Practice Address - Fax:253-403-2915
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT101180207Q00000X
WAMD.MD.61669853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine