Provider Demographics
NPI:1063692747
Name:DONALD F. CONDON, M.D.
Entity type:Organization
Organization Name:DONALD F. CONDON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REHFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-467-1100
Mailing Address - Street 1:9631 N NEVADA ST
Mailing Address - Street 2:STE 202
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1133
Mailing Address - Country:US
Mailing Address - Phone:509-467-1100
Mailing Address - Fax:509-468-0173
Practice Address - Street 1:9631 N NEVADA ST
Practice Address - Street 2:STE 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1133
Practice Address - Country:US
Practice Address - Phone:509-467-1100
Practice Address - Fax:509-468-0173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONALD F. CONDON, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-09
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016998261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0873820001OtherDMEC
WA756081728OtherMEDICARE RAIL ROAD
WA0873820001OtherDMEC
WA756081728OtherMEDICARE RAIL ROAD