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General NPI Number Information
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NPI Number | 1265049829
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Entity Type | Organization
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Legal Business Name | ROBERT I HUSTRULID MD PLLC
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 12/21/2020
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Provider Practice Location Address
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Address Line | 1201 N EVERGREEN RD
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-5094
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Country | US
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Telephone | 509-951-3979
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Fax | 509-495-1244
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Provider Business Mailing Address
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Address Line | 3807 S SOMMER RD
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City | VERADALE
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State | WA
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Zip | 99037-9136
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Country | US
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Telephone | 509-951-3979
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT IVER HUSTRULID
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Credential | MD
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Telephone | 509-951-3979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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