Healthcare Provider Details

I. General information

NPI: 1073593638
Provider Name (Legal Business Name): DIRK SPENCER SYPHERD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W 5TH AVE SUITE 801
SPOKANE WA
99204-2966
US

IV. Provider business mailing address

PO BOX 3649
SPOKANE WA
99220-3649
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-2531
  • Fax:
Mailing address:
  • Phone: 509-838-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberM8215
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number109260
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD00028526
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: