Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OP60017447 | WA |
Y | 207QS0010X | Family Doctor - Sports Medicine | OP60017447 | WA |
NPI | 1114192218 |
---|---|
Provider Name | Dr. Barbara Anne Brandon |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane Valley, WA 99216-1078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 23/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OL20000099 | MEDICAL LICENSE (01) | WA |