Provider Demographics
NPI:1083607477
Name:SPOKANE RADIATION ONCOLOGY ASSOCIATES P S
Entity Type:Organization
Organization Name:SPOKANE RADIATION ONCOLOGY ASSOCIATES P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-666-3800
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-0405
Mailing Address - Country:US
Mailing Address - Phone:208-667-9334
Mailing Address - Fax:208-664-2341
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2656
Practice Address - Country:US
Practice Address - Phone:208-666-3800
Practice Address - Fax:208-666-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN8904OtherRAILROAD MEDICARE
CN8904OtherRAILROAD MEDICARE