Provider Demographics
NPI:1669427449
Name:LILES, JEFFERY L (MD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:L
Last Name:LILES
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 1:9001 N COUNTRY HOMES BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2072
Mailing Address - Country:US
Mailing Address - Phone:833-411-5469
Mailing Address - Fax:855-459-3020
Practice Address - Street 1:9001 N COUNTRY HOMES BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2072
Practice Address - Country:US
Practice Address - Phone:833-411-5469
Practice Address - Fax:855-459-3020
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8894207R00000X
WAMD00042522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1040281Medicaid
ID806734200Medicaid
WAG8943921Medicare PIN
WA1040281Medicaid