Provider Demographics
NPI: | 1467451419 |
---|---|
Name: | MAPLES, MICHAEL W (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | MICHAEL |
Middle Name: | W |
Last Name: | MAPLES |
Suffix: | |
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: | 501 S 5TH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | YAKIMA |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98902-3550 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 509-574-6117 |
Mailing Address - Fax: | 509-573-6275 |
Practice Address - Street 1: | 501 S 5TH AVE |
Practice Address - Street 2: | |
Practice Address - City: | YAKIMA |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98902-3550 |
Practice Address - Country: | US |
Practice Address - Phone: | 509-494-6700 |
Practice Address - Fax: | 509-573-6275 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-20 |
Last Update Date: | 2015-05-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | MD00019391 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 8932820 | Other | CRIME VICTIM |
WA | 8545204 | Medicaid | |
WA | 0031695 | Other | LABOR & INDUSTRIES |
WA | P00050801 | Other | RAILROAD MEDICARE |
WA | A06866 | Medicare UPIN | |
WA | 8545204 | Medicaid | |
WA | P00050801 | Other | RAILROAD MEDICARE |