Provider Demographics
NPI:1902884869
Name:JOOSTEN, DAVID JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:JOOSTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-474-3568
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:5011 W LOWELL AVE STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8587
Practice Address - Country:US
Practice Address - Phone:509-385-0610
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040490208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8287823OtherDSHS NUMBER