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General NPI Number Information
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NPI Number | 1730890617
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Entity Type | Organization
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Legal Business Name | WANDERMERE FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 309 E FARWELL RD
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City | SPOKANE
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State | WA
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Zip | 99218-8210
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Country | US
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Telephone | 509-474-9838
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Fax | 509-474-9843
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Provider Business Mailing Address
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Address Line | 909 E HARDING DR
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City | SPOKANE
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State | WA
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Zip | 99218-4719
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Country | US
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Telephone | 509-474-9838
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NEIL GOLAN
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Credential | MD
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Telephone | 509-474-9838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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