MEDICARE: NATHAN CRAIG DIKES DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093818890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN CRAIG DIKES DPM

Provider Business Mailing Address
First Line	:	PO BOX 141689
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99214-1689
Country	:	US
Telephone Number	:	509-928-3338
Fax Number	:	509-232-0112

Provider Business Practice Location Address
First Line	:	10410 E 9TH AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-3510
Country	:	US
Telephone Number	:	509-928-3338
Fax Number	:	509-232-0112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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