Provider Demographics
NPI:1639188915
Name:STARIWAT, RICKY D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:D
Last Name:STARIWAT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1334
Mailing Address - Country:US
Mailing Address - Phone:509-838-2531
Mailing Address - Fax:
Practice Address - Street 1:400 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1334
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK479363A00000X, 363AM0700X, 363AS0400X
WAPA60276530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1611Medicaid
AK0000WCHGGMedicare ID - Type UnspecifiedMEDICARE GROUP ID
AK040012999Medicare ID - Type UnspecifiedMCRE RR RETIRE/GROUP
AKC12752Medicare ID - Type UnspecifiedMEDICARE RAILROAD
AKP00265411Medicare ID - Type UnspecifiedRAILROAD RETIRE/INDI
AKS90593Medicare UPIN