Healthcare Provider Details

I. General information

NPI: 1902806771
Provider Name (Legal Business Name): DAVID ANTONIO BECERRIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E TRENT AVE
SPOKANE WA
99202-2175
US

IV. Provider business mailing address

PO BOX 2112
COEUR D ALENE ID
83816-2112
US

V. Phone/Fax

Practice location:
  • Phone: 509-535-8510
  • Fax: 509-535-1635
Mailing address:
  • Phone: 509-535-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00021300
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-15965
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: