| Family Practice Associates Of Walla Walla Pllc | |
|
1017 S 2nd Ave Suite 2 Walla Walla WA 99362-4183 | |
| (509) 522-0606 | |
| Not Available |
| Full Name | Family Practice Associates Of Walla Walla Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1017 S 2nd Ave, Walla Walla, Washington |
| Authorized Official Name and Position | Dale T Fetroe (OWNER) |
| Authorized Official Contact | 5095220606 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Practice Associates Of Walla Walla Pllc Po Box 1663 Walla Walla WA 99362-0031 Ph: (509) 529-1284 | Family Practice Associates Of Walla Walla Pllc 1017 S 2nd Ave Suite 2 Walla Walla WA 99362-4183 Ph: (509) 522-0606 |
| NPI Number | 1467431726 |
|---|---|
| Provider Enumeration Date | 01/13/2006 |
| Last Update Date | 10/20/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467431726 | NPI | - | NPPES |
| 286465 | Medicaid | OR | |
| 7079858 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD00018950 (Washington) | Primary |
| 363L00000X | Nurse Practitioner | AP30002544 (Washington) | Secondary |
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