Provider Demographics
NPI:1669420477
Name:CAREY, COLLEEN R (MD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:R
Last Name:CAREY
Suffix:
Gender:F
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:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3868
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:910 W 5TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2966
Practice Address - Country:US
Practice Address - Phone:509-228-1635
Practice Address - Fax:509-252-9300
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00018205207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003628700Medicaid
WA1645902Medicaid
WA1645902Medicaid
ID003628700Medicaid