Provider Demographics
NPI:1821104399
Name:FINE, KURT PETTIS (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:PETTIS
Last Name:FINE
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 1:212 E CENTRAL AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6289
Mailing Address - Country:US
Mailing Address - Phone:509-484-1236
Mailing Address - Fax:509-484-2012
Practice Address - Street 1:212 E CENTRAL AVE STE 340
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6289
Practice Address - Country:US
Practice Address - Phone:509-484-1236
Practice Address - Fax:509-484-2012
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA37568207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1107697Medicaid
WAAB10736Medicare ID - Type Unspecified
WA1107697Medicaid