Healthcare Provider Details

I. General information

NPI: 1992184972
Provider Name (Legal Business Name): APPLE A DAY FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2015
Last Update Date: 05/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 SE PROFESSIONAL MALL BLVD SUITE 105
PULLMAN WA
99163-5423
US

IV. Provider business mailing address

1205 SE PROFESSIONAL MALL BLVD SUITE 105
PULLMAN WA
99163-5423
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-2400
  • Fax: 509-332-2402
Mailing address:
  • Phone: 509-332-2400
  • Fax: 509-332-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60041849
License Number StateWA

VIII. Authorized Official

Name: DR. MAXWELL WILLIAMS
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 509-332-2400