Provider Demographics
NPI:1174606107
Name:ONSTAD, JOHN W
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:ONSTAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3142
Mailing Address - Country:US
Mailing Address - Phone:509-248-1831
Mailing Address - Fax:509-452-6911
Practice Address - Street 1:401 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3142
Practice Address - Country:US
Practice Address - Phone:509-248-1831
Practice Address - Fax:509-452-6911
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014553207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8173700Medicaid
WA8173700Medicaid
WAD33934Medicare UPIN