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General NPI Number Information
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NPI Number | 1609159466
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Entity Type | Individual
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Provider Name | ANDREY V ALTUKHOV L.M.P
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Gender | Male
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 906 S. PARK RD
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City | SPOKANE VALLEY
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State | WA
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Zip | 99212
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Country | US
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Telephone | 509-999-9418
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Fax |
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Provider Business Mailing Address
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Address Line | 906 S PARK RD
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City | SPOKANE VALLEY
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State | WA
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Zip | 99212-3050
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Country | US
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Telephone | 509-999-9418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA60229230
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License Number State | WA
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