Healthcare Provider Details

I. General information

NPI: 1285369181
Provider Name (Legal Business Name): ALEC WILLIAM GREBE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MISSION AVE
SPOKANE WA
99201-2358
US

IV. Provider business mailing address

1509 E DALKE AVE
SPOKANE WA
99208-2707
US

V. Phone/Fax

Practice location:
  • Phone: 509-326-4343
  • Fax: 509-329-2280
Mailing address:
  • Phone: 509-638-9313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61372409
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: