MEDICARE: M.A. DEWOOD, M.D.,P.S.

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	261QM2500X	Medical Specialty Clinic/Center	MD 00014946	WA

General Provider Information

NPI Number	:	1417240920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.A. DEWOOD, M.D.,P.S.

Provider Business Mailing Address
First Line	:	901 N MONROE ST
Second Line	:	SUITE 250
City	:	SPOKANE
State	:	WA
Zip	:	99201-2104
Country	:	US
Telephone Number	:	509-455-4100
Fax Number	:	509-326-3500

Provider Business Practice Location Address
First Line	:	901 N MONROE ST
Second Line	:	SUITE 250
City	:	SPOKANE
State	:	WA
Zip	:	99201-2104
Country	:	US
Telephone Number	:	509-455-4100
Fax Number	:	509-326-3500

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARC A. DEWOOD
Credential	:	MD
Telephone Number	:	509-455-4100

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	05/17/2011

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