Provider Demographics
NPI:1003853227
Name:JOSEPH, SAMUEL GREG (DO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GREG
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W. 5TH AVE.
Mailing Address - Street 2:SUITE 400 W.
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4800
Mailing Address - Country:US
Mailing Address - Phone:509-353-3960
Mailing Address - Fax:509-625-7387
Practice Address - Street 1:104 W. 5TH AVE.
Practice Address - Street 2:SUITE 400 W.
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4800
Practice Address - Country:US
Practice Address - Phone:509-353-3960
Practice Address - Fax:509-625-7387
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001169174400000X, 207RP1001X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB28538Medicare ID - Type Unspecified