Individual
GUILLERMO MODAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
835 SE BISHOP BLVD, PULLMAN, WA 99163-5512
(509) 332-2541
Mailing address
PO BOX 8007, MOSCOW, ID 83843-0507
(208) 883-2224
(208) 883-6580
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD60995770
WA
208000000X
Pediatrics Physician
M-12525
ID
208M00000X
Hospitalist Physician
M-12525
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2010
Last updated
04/03/2026
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