Provider Demographics
NPI:1831188036
Name:LAMOREAUX, WAYNE TENNEY (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:TENNEY
Last Name:LAMOREAUX
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: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:509-228-1000
Mailing Address - Fax:509-252-9300
Practice Address - Street 1:1204 N VERCLER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1020
Practice Address - Country:US
Practice Address - Phone:509-228-1000
Practice Address - Fax:509-252-9300
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000446452085R0001X
IDM-122342085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010151249OtherBLUE SHIELD OF IDAHO
WA8421562Medicaid
P00236986OtherRAILROAD MEDICARE
ID807181200Medicaid
KAE01OtherBLUE CROSS OF IDAHO
7403749OtherAETNA
7627LAOtherASURIS NW HEALTH PLAN
WA0195424OtherLABOR & INDUSTRIES
P00236986OtherRAILROAD MEDICARE
ID807181200Medicaid
WAG8852968Medicare PIN