Healthcare Provider Details

I. General information

NPI: 1194760769
Provider Name (Legal Business Name): GILBERT R. ESCANDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 5TH AVE
SPOKANE WA
99204-2803
US

IV. Provider business mailing address

PO BOX 34640
SEATTLE WA
98124-1640
US

V. Phone/Fax

Practice location:
  • Phone: 509-458-5800
  • Fax: 509-473-4916
Mailing address:
  • Phone: 509-458-5800
  • Fax: 509-473-4916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00030462
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD00030462
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: