Healthcare Provider Details

I. General information

NPI: 1437338167
Provider Name (Legal Business Name): GREGORY BELENKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 S COEUR DALENE ST #D203
SPOKANE WA
99201-6452
US

IV. Provider business mailing address

166 S COEUR DALENE ST #D203
SPOKANE WA
99201-6452
US

V. Phone/Fax

Practice location:
  • Phone: 509-953-6035
  • Fax:
Mailing address:
  • Phone: 509-953-6035
  • Fax: 509-358-7810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00047310
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberMD00047310
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: