JON MARCUS RAYMOND MUNDALL (NPI# 1912185588) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912185588 |
| Entity Type | Individual |
| Full Name | JON MARCUS RAYMOND MUNDALL |
| Credential | M.D. |
| Practice Address |
111 North Columbia Ave Connell WA 99326 |
| Mailing Address |
Po Box F Connell WA 99326-0047 |
| Practice Telephone | 5092347766 |
| Practice Fax Number | 5092344320 |
| Mailing Telephone | 5092347766 |
| Mailing Fax Number | 5092344320 |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2008-02-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | MD00023408 | WA | Allopathic & Osteopathic Physicians |
| Street Address |
111 NORTH COLUMBIA AVE |
| City | CONNELL |
| State | WA |
| Zip Code | 99326 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104392935 | Lois Eileen Smith | Counselor | Coyote Ridge Correction Center, 1301 North Ephrata Ave., Connell, WA 99326 | 2018-10-19 |
| 1538589478 | George Francis Quiggle | Counselor | 1100 W. Grant St., Connell, WA 99326 | 2014-04-18 |
| 1528316379 | Columbia Basin Health Association | Clinic/Center | 1051 S. Columbia Avenue, Connell, WA 99326 | 2012-08-28 |
| 1295011617 | Gary Byron Fletcher | Physician Assistant | 111 N Columbia Avenue, Connell, WA 99326 | 2011-10-31 |
| 1871895987 | Jonathan Neau | Physician Assistant | 1301 N Ephrata Ave, Connell, WA 99326 | 2010-11-22 |
| 1417116385 | Columbia Basin Health Association | Clinic/Center | 1051 S Columbia Avenue, Connell, WA 99326 | 2008-06-05 |
| 1952355448 | Catherine Sue Bilyard | Nurse Practitioner | 650 S Columbia Ave, Connell, WA 99326 | 2006-05-20 |
| 1598749590 | Jaeniffer Ang Kaiser | Nurse Practitioner | 661 South Columbia Avenue, Connell, WA 99326 | 2005-12-02 |
| 1124025721 | Dale T Fetroe | Family Medicine | 1301 Ephrata, C/o Coyote Ridge Correction Center, Connell, WA 99326 | 2005-06-28 |
| 1538213616 | Our Lady of Lourdes Health Center | Clinic/Center | 650 S Columbia Ave, Connell, WA 99326 | 2007-01-23 |
| Find all providers in zip 99326 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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| 1255896601 | Emily Christine Buck | General Practice | 940 Fitzsimmons Dr, Tacoma, WA 98431-0001 | 2019-02-08 |
| 1740755651 | Alyssa Ann Yruegas | General Practice | 2108 W Spruce St, Moses Lake, WA 98837-2853 | 2018-10-06 |
| 1306321237 | Rainier Springs Physician Group, LLC | General Practice | 2805 Ne 129th Street, Vancouver, WA 98686 | 2018-09-26 |
| 1962916437 | Parkview Medical Group Inc | General Practice | 615 S Division St Ste A, Moses Lake, WA 98837-3800 | 2017-11-20 |
| 1790212496 | Thien Thanh Ho | General Practice | 12307 Douglas Rd, Yakima, WA 98908-9129 | 2017-05-12 |
| 1285173625 | Regenerative Medicine Institute, Pllc | General Practice | 731 N Stanley St, Medical Lake, WA 99022-8940 | 2017-02-17 |
| 1457708430 | James Bailey | General Practice | 9040 Jackson Ave Tripler Army Medical Center, Tacoma, WA 98431-5001 | 2016-05-19 |
| 1740635887 | Peter Chulhi Kang | General Practice | 1425 Spring St Apt 802, Seattle, WA 98104-1635 | 2016-04-26 |
| 1831551084 | Anna Hackenmiller | General Practice | 1657 S Nettleton Ln, Spokane, WA 99224-6108 | 2016-03-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.