Dierks, Travis Wade

Dierks, Travis Wade is an individual health care provider with primary practice located at 800 W 5Th Ave , Spokane WA 99204-2803. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medical Services, which is considered as his primary health care specialty. Dierks, Travis Wade can be contacted via phone (509) 458-5800.

Contact Information

Primary practice address
800 W 5Th Ave Spokane WA 99204-2803
Phone: (509) 458-5800
Fax: (509) 473-4916
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X MD60009256 Washington

Profile Details

NPI number 1982820965
LBN Legal business name Dierks, Travis Wade
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 18th, 2007
Last updated Aug 5th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982820965 NPPES
Idaho MEDICAID 808064500
Idaho MEDICAID 8515561
Idaho MEDICAID 1982820965
Idaho MEDICAID 1982820965
Idaho MEDICAID 1982820965
Idaho MEDICAID 500622449

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