Provider Demographics
NPI:1710234190
Name:MAYFIELD FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:MAYFIELD FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:509-413-2105
Mailing Address - Street 1:5901 N LIDGERWOOD ST STE 127
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1122
Mailing Address - Country:US
Mailing Address - Phone:509-413-2105
Mailing Address - Fax:509-413-2107
Practice Address - Street 1:5901 N LIDGERWOOD ST STE 127
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1122
Practice Address - Country:US
Practice Address - Phone:509-413-2105
Practice Address - Fax:509-413-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA16849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty