Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD00016007 | WA |
N | 111NI0900X | Internist | MD00016007 | WA |
Y | 207RH0002X | Hospice and Palliative Medicine | MD00016007 | WA |
NPI | 1063442200 |
---|---|
Provider Name | Bruce D Brazina |
First Address | University Place, WA 98466-4614 |
Second Address | University Place, WA 98466-4614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 12/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0199312 | STATE L&I (01) | WA |
1611201 | (05) | WA |
A08857 | (02) | WA |