Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD0021528 | WA |
NPI | 1043257702 |
---|---|
Provider Name | Dr. John J. Demakas |
First Address | Spokane, WA 99220-3649 |
Second Address | Spokane, WA 99204-2823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 16/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8617409 | (05) | WA |
A07800 | (02) | WA |