Provider Demographics
NPI:1093818890
Name:DIKES, NATHAN CRAIG (DPM)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:CRAIG
Last Name:DIKES
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:PO BOX 141689
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99214-1689
Mailing Address - Country:US
Mailing Address - Phone:509-928-3338
Mailing Address - Fax:509-232-0112
Practice Address - Street 1:10410 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3510
Practice Address - Country:US
Practice Address - Phone:509-928-3338
Practice Address - Fax:509-232-0112
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1094051Medicaid
U57230Medicare UPIN
WAAB24874Medicare ID - Type Unspecified