Provider Demographics
NPI:1184736407
Name:SANCHEZ, BARDOMIANO JR
Entity type:Individual
Prefix:DR
First Name:BARDOMIANO
Middle Name:
Last Name:SANCHEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BARDO
Other - Middle Name:
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15409 N FIRCREST CIR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8243
Mailing Address - Country:US
Mailing Address - Phone:509-466-6158
Mailing Address - Fax:509-466-6158
Practice Address - Street 1:5633 N LIDGERWOOD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1224
Practice Address - Country:US
Practice Address - Phone:509-252-6336
Practice Address - Fax:509-252-6337
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00395897OtherMEDICARE RAILROAD
WACG4026OtherMEDICARE RR GROUP
WA8470353Medicaid
WAG000362000OtherMEDICARE GROUP
WACG4026OtherMEDICARE RR GROUP
WACG4026OtherMEDICARE RR GROUP
WAGAB56267Medicare PIN