Healthcare Provider Details

I. General information

NPI: 1003890732
Provider Name (Legal Business Name): JEFFERY STUART GIVENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16528 E DESMET CT
SPOKANE VALLEY WA
99216-3522
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-944-8907
  • Fax:
Mailing address:
  • Phone: 866-944-9644
  • Fax: 509-944-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60080776
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: