Provider Demographics
NPI:1649253758
Name:PALOUSE PEDIATRICS, PLLC
Entity type:Organization
Organization Name:PALOUSE PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FROSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-332-2605
Mailing Address - Street 1:1205 SE PROFESSIONAL MALL BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5423
Mailing Address - Country:US
Mailing Address - Phone:509-332-2605
Mailing Address - Fax:509-334-5754
Practice Address - Street 1:1205 SE PROFESSIONAL MALL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5423
Practice Address - Country:US
Practice Address - Phone:509-332-2605
Practice Address - Fax:509-334-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB28378Medicare ID - Type Unspecified