Active NPI
John Lawrence Headley, M.D.
- MOHS-Micrographic Surgery Physician
- Edmonds, WA
National Provider Identifier
1528093861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- MOHS-Micrographic Surgery Physician
- License
- MD00018010
- Practice address
- 21600 Highway 99
#280
Edmonds, WA 98026-8012 - Phone
- (425) 774-2616
- Fax
- (425) 774-2660
- NPI assigned
- Jul 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| MOHS-Micrographic Surgery Physician | 207ND0101X | MD00018010 | WA | Primary |
Addresses
Primary practice location
21600 Highway 99
#280
Edmonds, WA 98026-8012
Mailing address
21600 Highway 99
#280
Edmonds, WA 98026-8012
Phone (425) 774-2616
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1030683 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00018010 | WA | MD | MOHS-Micrographic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528093861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21600 HIGHWAY 99",
"address_2": "#280",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980268012",
"telephone_number": "425-774-2616",
"fax_number": "425-774-2660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21600 HIGHWAY 99",
"address_2": "#280",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980268012",
"telephone_number": "425-774-2616",
"fax_number": "425-774-2660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEADLEY",
"first_name": "JOHN",
"middle_name": "LAWRENCE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207ND0101X",
"taxonomy_group": "",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": "WA",
"license": "MD00018010",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1030683",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edmonds, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.