Provider Demographics
NPI:1255380788
Name:CANADAY, DONALD B (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:B
Last Name:CANADAY
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 1:801 W 5TH AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2823
Mailing Address - Country:US
Mailing Address - Phone:509-838-2531
Mailing Address - Fax:509-755-6580
Practice Address - Street 1:801 W 5TH AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2823
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:509-755-6580
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00021524207RC0000X, 207RI0011X
IDM-4818207RC0000X
WAMD00021524207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8619900Medicaid
ID0003628Medicaid
OR0055509Medicaid
ID003628000Medicaid
ID11407461Medicare PIN
OR105328Medicare PIN
WAG000352401Medicare PIN
A07698Medicare UPIN
WA000352401Medicare ID - Type Unspecified
ID003628000Medicaid