Individual
MULLOY G HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
338 6TH ST STE 101, LEWISTON, ID 83501-2419
(120) 884-8830
(509) 444-7806
Mailing address
203 N WASHINGTON ST STE 300, SPOKANE, WA 99201-0233
(509) 444-8888
(509) 444-7806
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-10654
ID
207Q00000X
Family Medicine Physician
MD00015580
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7081771
—
WA
Enumeration date
10/15/2007
Last updated
06/29/2011
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