Provider Demographics
NPI:1003890732
Name:GIVENS, JEFFERY STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:STUART
Last Name:GIVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-944-9644
Mailing Address - Fax:509-944-9644
Practice Address - Street 1:16528 E DESMET CT
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3522
Practice Address - Country:US
Practice Address - Phone:509-944-8907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60080776207Q00000X
IDM-10515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR930635514OtherGROUP TAX NUMBER
ORCD8723OtherRR MEDICARE GROUP NUMBER
ORR0000WFBTVOtherGROUP PIN NUMBER
OR080103355OtherRR MEDICARE PTAN NUMBER
OR081443Medicaid
OR1407812365OtherNBMC NPI NUMBER-GROUP
OR930635514OtherGROUP TAX NUMBER
OR1407812365OtherNBMC NPI NUMBER-GROUP
OR080103355OtherRR MEDICARE PTAN NUMBER