Healthcare Provider Details

I. General information

NPI: 1942244223
Provider Name (Legal Business Name): WILLIAM LEWIS DIENST JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S. WESTERN AVENUE
TONASKET WA
98855-8803
US

IV. Provider business mailing address

203 S. WESTERN AVENUE
TONASKET WA
98855-8803
US

V. Phone/Fax

Practice location:
  • Phone: 509-486-2151
  • Fax: 509-486-3119
Mailing address:
  • Phone: 509-486-2151
  • Fax: 509-486-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00025927
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: