Healthcare Provider Details

I. General information

NPI: 1962563130
Provider Name (Legal Business Name): DOUGLAS K MONSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 W NORTH RIVER DR
SPOKANE WA
99201-3208
US

IV. Provider business mailing address

322 W NORTH RIVER DR STE B
SPOKANE WA
99201-3208
US

V. Phone/Fax

Practice location:
  • Phone: 509-241-2074
  • Fax:
Mailing address:
  • Phone: 509-241-2074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO 00000388
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: