Healthcare Provider Details

I. General information

NPI: 1962491985
Provider Name (Legal Business Name): MARYAM PARVIZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S SHERMAN ST
SPOKANE WA
99202-1311
US

IV. Provider business mailing address

PO BOX 3868
SPOKANE WA
99220-3868
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 TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD00042177
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: