Healthcare Provider Details

I. General information

NPI: 1760543755
Provider Name (Legal Business Name): ORLAN KENNETH MACDONALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E HOLLAND AVE STE 100
SPOKANE WA
99218-1246
US

IV. Provider business mailing address

1204 N VERCLER RD
SPOKANE VALLEY WA
99216-1020
US

V. Phone/Fax

Practice location:
  • Phone: 509-228-1000
  • Fax: 509-252-9300
Mailing address:
  • Phone: 509-228-1000
  • Fax: 509-252-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberM-15580
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number49563
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number04-34454
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2010017189
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number50508
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number5414475-1205
License Number StateUT
# 7
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD61124988
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: