Healthcare Provider Details

I. General information

NPI: 1982910329
Provider Name (Legal Business Name): JORDAN V ESPIRITU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15812 E INDIANA AVE
SPOKANE VALLEY WA
99216-1875
US

IV. Provider business mailing address

203 N WASHINGTON ST STE 300
SPOKANE WA
99201-0254
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8200
  • Fax: 509-444-8206
Mailing address:
  • Phone: 509-444-8888
  • Fax: 509-444-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60322314
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: