Provider Demographics
NPI:1114943669
Name:INLAND OBGYN
Entity Type:Organization
Organization Name:INLAND OBGYN
Other - Org Name:NORTHWEST OBGYN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAKKIANATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-455-5050
Mailing Address - Street 1:105 W 8TH AVE STE 6020
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2319
Mailing Address - Country:US
Mailing Address - Phone:509-455-5050
Mailing Address - Fax:509-789-6204
Practice Address - Street 1:105 W 8TH AVE STE 6020
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2319
Practice Address - Country:US
Practice Address - Phone:509-455-5050
Practice Address - Fax:509-789-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018379207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA319210500Medicare ID - Type Unspecified