Healthcare Provider Details

I. General information

NPI: 1417029661
Provider Name (Legal Business Name): THOMAS A MCGERTY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N LIDGERWOOD ST STE 126 SUITE 126
SPOKANE WA
99208-1122
US

IV. Provider business mailing address

203 N WASHINGTON ST STE 300
SPOKANE WA
99201-0254
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8200
  • Fax: 509-340-8986
Mailing address:
  • Phone: 509-444-8888
  • Fax: 509-444-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOP00001105
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number2910
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: