Organization
SPOKANE ENT CLINIC MAYFAIR
Active
Organization
SPOKANE ENT CLINIC MAYFAIR
Active
Other names
JAN S CONNELLY MD
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
5901 N MAYFAIR ST, SPOKANE, WA 99208-5096
(509) 489-3514
(509) 483-2546
Mailing address
5901 N MAYFAIR ST, SPOKANE, WA 99208-5096
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
MD00019284
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4931906
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/20/2006
Last updated
08/22/2020
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