Provider Demographics
NPI:1861900631
Name:JOHN ABANO MD PLLC
Entity type:Organization
Organization Name:JOHN ABANO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-687-7638
Mailing Address - Street 1:20011 BALLINGER WAY NE STE C100
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1298
Mailing Address - Country:US
Mailing Address - Phone:206-687-7638
Mailing Address - Fax:206-906-9981
Practice Address - Street 1:20011 BALLINGER WAY NE STE C100
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1298
Practice Address - Country:US
Practice Address - Phone:206-687-7638
Practice Address - Fax:206-906-9981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60242421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty