Healthcare Provider Details

I. General information

NPI: 1659330363
Provider Name (Legal Business Name): ANTHONY ANDREW BOTTONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 8TH AVE
SPOKANE WA
99204-2302
US

IV. Provider business mailing address

910 N WASHINGTON ST STE 209
SPOKANE WA
99201-2202
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-6920
  • Fax:
Mailing address:
  • Phone: 509-232-1145
  • Fax: 509-232-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5469
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: