Organization
JOHN N DIACONOU MD PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYNE TWEIT (CLINIC MANAGER)
(253) 833-8032
Entity
Organization
Contact information
Practice address
34509 9TH AVE S, SUITE 102, FEDERAL WAY, WA 98003-6700
(253) 833-8032
Mailing address
202 N DIVISION, SUITE 402, AUBURN, WA 98001-4939
(253) 833-8032
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD00018742
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0152713
LABOR AND INDUSTRIES
WA
05
—
1779008
—
WA
01
—
D522
REGENCE BLUE SHIELD
WA
Enumeration date
04/25/2008
Last updated
05/02/2008
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