Individual
DR. TRAVIS WADE DIERKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 W 5TH AVE, SPOKANE, WA 99204-2803
(509) 458-5800
(509) 473-4916
Mailing address
PO BOX 34640, SEATTLE, WA 98124-1640
(509) 458-5800
(508) 473-4916
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
MD60009256
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982820965
—
ID
05
—
1982820965
—
MT
05
—
1982820965
—
WA
05
—
500622449
—
OR
05
—
808064500
—
ID
05
—
8515561
—
WA
Enumeration date
04/18/2007
Last updated
08/05/2010
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