Provider Demographics
NPI:1891982385
Name:CAROL R GUTHRIE MD
Entity Type:Organization
Organization Name:CAROL R GUTHRIE MD
Other - Org Name:SPOKANE BREAST CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-455-9550
Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-455-9550
Mailing Address - Fax:509-456-3342
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2322
Practice Address - Country:US
Practice Address - Phone:509-455-9550
Practice Address - Fax:509-456-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032018208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7118524Medicaid
WAGAB38551Medicare PIN