MEDICARE: DR. LON C. MADSEN DO

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	207Q00000X	Family Medicine Physician	008315	AZ
2	207Q00000X	Family Medicine Physician	OP00001511	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	008315	OTHER	AZ	ARIZONA MEDICAL BOARD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558433052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LON C. MADSEN DO

Provider Business Mailing Address
First Line	:	9708 N NEVADA ST STE 203
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-6004
Country	:	US
Telephone Number	:	509-863-9240
Fax Number	:	509-574-5863

Provider Business Practice Location Address
First Line	:	9708 N NEVADA ST STE 203
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-6004
Country	:	US
Telephone Number	:	509-863-9240
Fax Number	:	509-574-5863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. LON C. MADSEN DO” Practice Location

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