Provider Demographics
NPI:1558433052
Name:MADSEN, LON C (DO)
Entity Type:Individual
Prefix:DR
First Name:LON
Middle Name:C
Last Name:MADSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9708 N NEVADA ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-6004
Mailing Address - Country:US
Mailing Address - Phone:509-863-9240
Mailing Address - Fax:509-574-5863
Practice Address - Street 1:9708 N NEVADA ST STE 203
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-6004
Practice Address - Country:US
Practice Address - Phone:509-863-9240
Practice Address - Fax:509-574-5863
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ008315207Q00000X
WAOP00001511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ008315OtherARIZONA MEDICAL BOARD
AZ008538Medicaid
AZ008538Medicaid