Randal P Defelice, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

00025327 Issued in WA

Practice address

5633 N Lidgerwood St
Spokane, WA 99208-1224

Phone

(509) 484-8069

Fax

(509) 462-4069

NPI assigned

Feb 12, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297728000000",
    "number": "1528100393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5633 N LIDGERWOOD ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992081224",
            "telephone_number": "509-482-2448",
            "fax_number": "509-482-2452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5633 N LIDGERWOOD ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992081224",
            "telephone_number": "509-484-8069",
            "fax_number": "509-462-4069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFELICE",
        "first_name": "RANDAL",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2011-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "00025327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8007353",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "G000362000",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "GAB02213",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Patrick Dedominick, BA
• Nathaniel Lawrence Deering, PHARMD
• Adam A Defaa
• Armand V Defelice, DDS
• Louise C Defelice, DDS
• Ron Defoe
• Debra Sue Defrates, RD
• Kari M Defreese, LMP
• Nicholas L Degroat, OTR/L
• Julie A Dehart, P.T.

• Emergency Medicine Physician in Spokane, WA
• Providers in Spokane, WA by specialty
• Emergency Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; 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.