Individual
DR. JOHN JOSEPH KONIKKARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-7800
Mailing address
8157 SOUTHWESTERN BLVD, APARTMENT# 142, DALLAS, TX 75206-2019
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
MD60704069
WA
2084P0800X
Psychiatry Physician
MD60704069
WA
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
Primary
MD60704069
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2070508
—
WA
Enumeration date
06/30/2008
Last updated
04/10/2017
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