Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 2458 | MT |
N | 213EG0000X | General Practice | 2458 | MT |
Y | 1223G0001X | General Practice | DE60291946 | WA |
Y | 213EG0000X | General Practice | DE60291946 | WA |
NPI | 1003108820 |
---|---|
Provider Name | Dr. Paul Clark Fawson III |
First Address | Spokane, WA 99203-3961 |
Second Address | Spokane, WA 99203-3961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2011 |
Last Update Date | 23/04/2013 |