Healthcare Provider Details

I. General information

NPI: 1831245349
Provider Name (Legal Business Name): MICHAEL SCOTT OERTLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 N LIDGERWOOD ST
SPOKANE WA
99208-1224
US

IV. Provider business mailing address

5633 N LIDGERWOOD ST
SPOKANE WA
99208-1224
US

V. Phone/Fax

Practice location:
  • Phone: 509-482-2448
  • Fax: 509-482-2452
Mailing address:
  • Phone: 509-482-2448
  • Fax: 509-482-2452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number101588
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.135443
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number61350329
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: