Provider Demographics
NPI:1750311775
Name:HATFIELD, LON MARSH (MD,PHD)
Entity Type:Individual
Prefix:
First Name:LON
Middle Name:MARSH
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2834
Mailing Address - Country:US
Mailing Address - Phone:509-685-2300
Mailing Address - Fax:509-685-0358
Practice Address - Street 1:150 S ELM ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2834
Practice Address - Country:US
Practice Address - Phone:509-685-2300
Practice Address - Fax:509-685-0358
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB27164Medicare ID - Type Unspecified
WAA07678Medicare UPIN