Provider Demographics
NPI:1720078678
Name:HATHEWAY, JOHN ALDEN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALDEN
Last Name:HATHEWAY
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 1:421 W RIVERSIDE AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0405
Mailing Address - Country:US
Mailing Address - Phone:509-863-9789
Mailing Address - Fax:855-630-0757
Practice Address - Street 1:421 W. RIVERSIDE AVE.
Practice Address - Street 2:SUITE 900
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-863-9789
Practice Address - Fax:855-630-0757
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10342207L00000X, 207LP2900X
WAMD00047514207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0061183Medicaid
ID806603300Medicaid
ID806603300Medicaid
MT0061183Medicaid