Organization
PHYSICIAN ANESTHESIA GROUP PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REX PORTER MD (DELEGATE)
(509) 838-8561
Entity
Organization
Contact information
Practice address
104 W 5TH AVE, SUITE 230E, SPOKANE, WA 99204-4880
(509) 838-8561
(509) 835-4058
Mailing address
104 W 5TH AVE, SUITE 230E, SPOKANE, WA 99204-4880
(509) 838-8561
(509) 835-4058
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7847700
—
WA
Enumeration date
05/24/2006
Last updated
03/14/2008
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