Provider Demographics
NPI:1417240920
Name:M.A. DEWOOD, M.D.,P.S.
Entity Type:Organization
Organization Name:M.A. DEWOOD, M.D.,P.S.
Other - Org Name:M.A. DEWOOD, M.D.,P.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-455-4100
Mailing Address - Street 1:901 N MONROE ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2104
Mailing Address - Country:US
Mailing Address - Phone:509-455-4100
Mailing Address - Fax:509-326-3500
Practice Address - Street 1:901 N MONROE ST
Practice Address - Street 2:SUITE 250
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2104
Practice Address - Country:US
Practice Address - Phone:509-455-4100
Practice Address - Fax:509-326-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00014946261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty