Healthcare Provider Details

I. General information

NPI: 1922256478
Provider Name (Legal Business Name): DAWIT GEBREKIDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 03/17/2018
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

101 W 8TH AVE PROVIDENCE MEDICAL GROUP
SPOKANE WA
99204-2307
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-2531
  • Fax: 509-755-6580
Mailing address:
  • Phone: 509-474-3262
  • Fax: 509-474-3245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60331984
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: