Healthcare Provider Details

I. General information

NPI: 1982693768
Provider Name (Legal Business Name): IRVIN G ENGEN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N MAYFAIR ST SUITE 202
SPOKANE WA
99208-1121
US

IV. Provider business mailing address

5901 N MAYFAIR ST SUITE 202
SPOKANE WA
99208-1121
US

V. Phone/Fax

Practice location:
  • Phone: 509-482-0848
  • Fax: 509-482-0760
Mailing address:
  • Phone: 509-482-0848
  • Fax: 509-482-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number202
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: