Provider Demographics
NPI:1982693768
Name:ENGEN, IRVIN G (DPM)
Entity Type:Individual
Prefix:
First Name:IRVIN
Middle Name:G
Last Name:ENGEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 N MAYFAIR ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1121
Mailing Address - Country:US
Mailing Address - Phone:509-482-0848
Mailing Address - Fax:509-482-0760
Practice Address - Street 1:5901 N MAYFAIR ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1121
Practice Address - Country:US
Practice Address - Phone:509-482-0848
Practice Address - Fax:509-482-0760
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA202213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1021906Medicaid
WAT02289Medicare UPIN