Provider Demographics
NPI:1811171317
Name:JOHN T DROESCH MD PLLC
Entity type:Organization
Organization Name:JOHN T DROESCH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DROESCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-946-9707
Mailing Address - Street 1:969 STEVENS DR
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-946-9707
Mailing Address - Fax:509-946-8145
Practice Address - Street 1:969 STEVENS DR
Practice Address - Street 2:SUITE 1-C
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-946-9707
Practice Address - Fax:509-946-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044432208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1122571Medicaid
WA1122571Medicaid
WAI41540Medicare UPIN