Family Practice Associates of Walla Walla PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00018950 Issued in WA

Legal business name

FAMILY PRACTICE ASSOCIATES OF WALLA WALLA PLLC

Practice address

1017 S 2ND Ave
Suite 2
Walla Walla, WA 99362-4183

Phone

(509) 522-0606

NPI assigned

Jan 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dale T Fetroe, MD

Title

Owner

Phone

(509) 522-0606

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192838400000",
    "number": "1467431726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1663",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993620031",
            "telephone_number": "509-529-1284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 S 2ND AVE",
            "address_2": "SUITE 2",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624183",
            "telephone_number": "509-522-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE ASSOCIATES OF WALLA WALLA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-13",
        "last_updated": "2007-10-20",
        "status": "A",
        "authorized_official_last_name": "FETROE",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-522-0606",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00018950",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP30002544",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286465",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7079858",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.