Basic Information
| Provider Information | |||||||||
| NPI: | 1841353711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERRIGAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1313 BROADWAY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984023400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534266306 | ||||||||
| FaxNumber: | 2534266344 | ||||||||
| Practice Location | |||||||||
| Address1: | 11315 BRIDGEPORT WAY SW | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539856403 | ||||||||
| FaxNumber: | 2539852948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD00030834 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 013194010 | 01 | WA | GROUP HEALTH COOPERATIVE | OTHER | 911577098-06 | 01 | WA | KITSAP PHYSICIANS SERVICE | OTHER | 050028289 | 01 | WA | RAILROAD MEDICARE | OTHER | 050028289 | 01 | RAILROAD MEDICARE | OTHER | 911577098 | 01 | WA | PREMEREA BLUE CROSS | OTHER | 192575000 | 01 | WA | OWCP | OTHER | 911577098 | 01 | WA | UNIFORM MEDICAL PLAN | OTHER | 1086214 | 05 | WA | MEDICAID | 0246538 | 01 | WA | STATE L&I | OTHER | 36251 | 01 | WA | LABOR AND INDUSTRIES | OTHER | KE3250 | 01 | WA | REGENCE | OTHER |