Individual
JOHN MACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
711 E COLLINS DR, GOLDENDALE, WA 98620-9237
(509) 773-4017
(509) 773-1941
Mailing address
310 S ROOSEVELT AVE, GOLDENDALE, WA 98620-9201
(509) 773-4022
(509) 773-1941
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00016704
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1351907
—
WA
Enumeration date
11/16/2006
Last updated
12/22/2009
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