Provider Demographics
NPI:1528098928
Name:DROESCH, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:DROESCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3900 S ZINTEL WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5092
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:1100 GOETHALS DRIVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3304
Practice Address - Country:US
Practice Address - Phone:509-942-3185
Practice Address - Fax:509-946-1850
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00044432208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1528098928Medicaid
WA1122571Medicaid
WA1528098928Medicaid
WAG8916226Medicare PIN