Provider Demographics
NPI:1962563551
Name:DIRE, EUGENE RAYMOND (MED)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:RAYMOND
Last Name:DIRE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 N LUCIA CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9676
Mailing Address - Country:US
Mailing Address - Phone:509-467-0497
Mailing Address - Fax:
Practice Address - Street 1:1212 W SHARP AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2600
Practice Address - Country:US
Practice Address - Phone:509-358-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health