Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | OP61135640 | WA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | OP61135640 | WA |
NPI | 1588012900 |
---|---|
Provider Name | Dr. Justin Brohard |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98104-2420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2016 |
Last Update Date | 19/01/2022 |