IndividualActive
Charles Ibeziako, MD
NPI 1093695249 · Family Medicine Physician · Othello, WA
Provider details
- NPI number
- 1093695249
- Entity type
- Individual
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- ML70050698 (WA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1515 E Columbia St
Othello, WA 99344-1846
Phone: (509) 488-5256
Fax: (509) 488-9939
Approximate (ZIP-level) locationGet directions
Mailing address
1515 E Columbia St
Othello, WA 99344-1846
Additional practice locations (1)
- 601 Government RdMattawa, WA 99349-5120Phone: (509) 488-5256Fax: (509) 488-9939
Registry dates
- Enumerated
- 2025-09-06
- Last updated
- 2025-09-23
- Certified
- 2025-09-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.