MEDICARE: DONALD F. CONDON, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	MD00016998	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	756081728	OTHER	WA	MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0873820001	OTHER	WA	DMEC

General Provider Information

NPI Number	:	1063692747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD F. CONDON, M.D.

Provider Business Mailing Address
First Line	:	9631 N NEVADA ST
Second Line	:	STE 202
City	:	SPOKANE
State	:	WA
Zip	:	99218-1133
Country	:	US
Telephone Number	:	509-467-1100
Fax Number	:	509-468-0173

Provider Business Practice Location Address
First Line	:	9631 N NEVADA ST
Second Line	:	STE 202
City	:	SPOKANE
State	:	WA
Zip	:	99218-1133
Country	:	US
Telephone Number	:	509-467-1100
Fax Number	:	509-468-0173

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KEN REHFELD
Credential	:
Telephone Number	:	509-467-1100

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	10/29/2008

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