Healthcare Provider Details

I. General information

NPI: 1992907208
Provider Name (Legal Business Name): DERK AUGUST MUELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

1899 N WINROCK ST
LIBERTY LAKE WA
99019-9491
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-5233
  • Fax:
Mailing address:
  • Phone: 509-210-4549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number60153803
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number11012049A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: