Healthcare Provider Details

I. General information

NPI: 1811330954
Provider Name (Legal Business Name): MICHAEL T BAYONA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S COWLEY ST
SPOKANE WA
99202-1381
US

IV. Provider business mailing address

PO BOX 13
GREENACRES WA
99016-0013
US

V. Phone/Fax

Practice location:
  • Phone: 479-879-4375
  • Fax:
Mailing address:
  • Phone: 479-879-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number161916
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2020020776
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0443996
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: