Healthcare Provider Details

I. General information

NPI: 1649295866
Provider Name (Legal Business Name): CHRISTOPHER J IACOBELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 200
PULLMAN WA
99163-5537
US

IV. Provider business mailing address

66 N 6TH ST
POMEROY WA
99347-9705
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-2517
  • Fax: 509-334-9247
Mailing address:
  • Phone: 509-843-1591
  • Fax: 509-843-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-12956
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301074411
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60568380
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: