Healthcare Provider Details

I. General information

NPI: 1053481200
Provider Name (Legal Business Name): KIRK MACLENNAN HERRING DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 N MCDONALD ROAD SUITE 201
SPOKANE VALLEY WA
99216
US

IV. Provider business mailing address

1215 N MCDONALD ROAD SUITE 201
SPOKANE VALLEY WA
99216
US

V. Phone/Fax

Practice location:
  • Phone: 509-926-1559
  • Fax: 509-926-1550
Mailing address:
  • Phone: 509-926-1559
  • Fax: 509-926-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP0000464
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: