Individual
THEODORE EUGENE JOHNSRUDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9398 RIDGETOP BLVD NW, SILVERDALE, WA 98383-8505
(360) 782-3200
(360) 782-3245
Mailing address
2512 WHEATON WAY, BREMERTON, WA 98310-3399
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD00019724
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5358025
AETNA
—
01
—
75433
LABOR & INDUSTRIES
WA
05
—
8316200
—
WA
01
—
JO4187
REGENCE BLUE SHIELD
—
Enumeration date
05/17/2006
Last updated
03/07/2023
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