Provider Demographics
NPI:1538241930
Name:VACCARO, JOHN ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:VACCARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3124 S 19TH ST
Mailing Address - Street 2:STE 320
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2433
Mailing Address - Country:US
Mailing Address - Phone:253-301-5100
Mailing Address - Fax:253-301-5101
Practice Address - Street 1:3124 S 19TH ST
Practice Address - Street 2:STE 320
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2433
Practice Address - Country:US
Practice Address - Phone:253-301-5100
Practice Address - Fax:253-301-5101
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA600180340208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology