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Individual

DR. THEODORE C KOUTLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
62 W 7TH AVE STE 110, SPOKANE, WA 99204-2321
(509) 456-0262
(509) 462-5059
Mailing address
62 W 7TH AVE STE 110, SPOKANE, WA 99204-2321
(509) 456-0262
(509) 462-5059

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
36754
NC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
M-12098
ID
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MD60367366
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
330004170
RAILROAD MEDICARE
NC
01
50281
BCBS NC
NC
05
8950281
NC
Enumeration date
08/22/2005
Last updated
06/16/2021
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