Healthcare Provider Details

I. General information

NPI: 1679534432
Provider Name (Legal Business Name): LARS THOMAS CONWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13103 E MANSFIELD AVE
SPOKANE VALLEY WA
99216-1642
US

IV. Provider business mailing address

PO BOX 3405
SPOKANE WA
99220-3405
US

V. Phone/Fax

Practice location:
  • Phone: 509-892-2700
  • Fax: 509-892-2740
Mailing address:
  • Phone: 509-892-2700
  • Fax: 509-342-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMED-PHYS-LIC-118222
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberM-12068
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD60314310
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number165109
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number9164A
License Number StateWY
# 6
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number9164A
License Number StateWY
# 7
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number165109
License Number StateAK
# 8
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD60314310
License Number StateWA
# 9
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMED-PHYS-LIC-118222
License Number StateMT
# 10
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberM-12068
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: