Individual
JERRY JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1901 S CEDAR ST STE 101, TACOMA, WA 98405-2302
(253) 301-5370
(253) 301-5379
Mailing address
PO BOX 5299, MS: 820-5-PCO, TACOMA, WA 98415-0299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
200501438
NC
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
0101274896
VA
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
MD61593680
WA
207RC0000X
Cardiovascular Disease Physician
5210479-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140XV
BCBS OF NC
NC
05
—
1659440543
—
UT
01
—
183494
MEDCOST
NC
05
—
2317636
—
WA
05
—
5902155
—
NC
01
—
807070
PARTNERS MEDICARE
NC
Enumeration date
11/07/2006
Last updated
12/24/2025
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