Individual
JOHN PORTER MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
105 W 8TH AVE, STE 6055, SPOKANE, WA 99204-2302
(509) 455-9090
(509) 747-2118
Mailing address
105 W 8TH AVE, STE 6055, SPOKANE, WA 99204-2302
(509) 455-9090
(509) 747-2118
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD00015837
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1048644
—
WA
Enumeration date
06/07/2006
Last updated
07/25/2007
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