Provider Demographics
NPI:1063450765
Name:GASCOIGNE, RICHARD HOLT JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HOLT
Last Name:GASCOIGNE
Suffix:JR
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 1:400 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1334
Mailing Address - Country:US
Mailing Address - Phone:509-838-2531
Mailing Address - Fax:509-459-1597
Practice Address - Street 1:400 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1334
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:509-459-1597
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041912207Q00000X
MI4301078995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA166912OtherDEPT. OF L & I
WAG8868666OtherMEDICARE PTAN
WAAB32999OtherMEDICARE GROUP
WA8350050Medicaid
WA8350050Medicaid
WAFG2238788OtherDEA
WAG8868666OtherMEDICARE PTAN
BG7489417OtherDEA