Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | BC60234085 | WA |
NPI | 1003079294 |
---|---|
Provider Name | Wilfred Alex Madarang |
First Address | Spokane, WA 99202-4932 |
Second Address | Spokane Valley, WA 99216-1875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 16/11/2021 |