Healthcare Provider Details

I. General information

NPI: 1659580769
Provider Name (Legal Business Name): ELIZABETH O'HALLORAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 E HAWTHORNE RD
SPOKANE WA
99218-1417
US

IV. Provider business mailing address

PO BOX 462
LIBERTY LAKE WA
99019-0462
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-2072
  • Fax:
Mailing address:
  • Phone: 509-474-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00047039
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD27074
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: