Provider Demographics
NPI:1053481200
Name:HERRING, KIRK MACLENNAN (DPM)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:MACLENNAN
Last Name:HERRING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N MCDONALD ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216
Mailing Address - Country:US
Mailing Address - Phone:509-926-1559
Mailing Address - Fax:509-926-1550
Practice Address - Street 1:1215 N MCDONALD ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-926-1559
Practice Address - Fax:509-926-1550
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP0000464213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1080274Medicaid
33897OtherLABOR & INDUSTRY
480012182OtherRAILROAD MEDICARE
G000304750Medicare ID - Type Unspecified
U00877Medicare UPIN
WA1080274Medicaid