Provider Demographics
NPI:1912152604
Name:BEGLEY, JOHN D III (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:BEGLEY
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:DANIEL
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9631 N NEVADA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1134
Mailing Address - Country:US
Mailing Address - Phone:509-625-3760
Mailing Address - Fax:509-625-3789
Practice Address - Street 1:9631 N NEVADA ST STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1134
Practice Address - Country:US
Practice Address - Phone:509-625-3760
Practice Address - Fax:509-625-3789
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60188560363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant