Organization
NORTHSIDE INTERNAL MEDICINE ASSOCIATES PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY J GARDNER MD (PRESIDENT)
(509) 489-7483
Entity
Organization
Contact information
Practice address
6120 N MAYFAIR, SPOKANE, WA 99208
(509) 489-7483
(509) 489-4572
Mailing address
6120 N MAYFAIR, SPOKANE, WA 99208
(509) 489-7483
(509) 489-4572
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7300015
—
WA
Enumeration date
06/06/2006
Last updated
12/18/2009
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