Individual
MR. MICHAEL JACKS MAINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3754 W INDIAN TRAIL RD, SPOKANE, WA 99208-4700
(509) 328-7041
(509) 328-7582
Mailing address
3754 W INDIAN TRAIL RD, SPOKANE, WA 99208-4700
(509) 328-7041
(509) 328-7582
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD00015454
WA
207Q00000X
Family Medicine Physician
Primary
MD00015454
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0195465
WORKERS' COMP
WA
05
—
1105303
—
WA
01
—
P00209862
RAILROAD MEDICARE
WA
Enumeration date
05/18/2006
Last updated
11/21/2018
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