Provider Demographics
NPI:1972597896
Name:DEMEYERE, AARON M (MD)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:M
Last Name:DEMEYERE
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 1:1623 5TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403
Mailing Address - Country:US
Mailing Address - Phone:509-758-1102
Mailing Address - Fax:509-758-1361
Practice Address - Street 1:1623 5TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403
Practice Address - Country:US
Practice Address - Phone:509-758-1102
Practice Address - Fax:509-758-1361
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-09-11
Provider Licenses
StateLicense IDTaxonomies
WAMD00033091207V00000X
IDM4776207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
994030000OtherTRICARE
ID47761OtherBLUE CROSS OF IDAHO
P00078763OtherRAILROAD MEDICARE
ID000254500Medicaid
ID000010005706OtherREGENCE BLUE SHIELD OF ID
WA1000298Medicaid
WA319000168Medicare ID - Type Unspecified
C36929Medicare UPIN
ID000254500Medicaid