Provider Demographics
NPI:1821100223
Name:BALE, RICHARD HOTCHKISS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HOTCHKISS
Last Name:BALE
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 1:404 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2110
Mailing Address - Country:US
Mailing Address - Phone:509-838-8538
Mailing Address - Fax:509-455-8761
Practice Address - Street 1:404 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2110
Practice Address - Country:US
Practice Address - Phone:509-838-8538
Practice Address - Fax:509-455-8761
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
13547OtherLABOR & INDUSTRIES
WA1111665Medicaid
080165874OtherPALMETTO RR MEDICARE
13547OtherLABOR & INDUSTRIES
A07714Medicare UPIN