Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 00025359 | WA |
NPI | 1326154881 |
---|---|
Provider Name | James Vincent Brasch |
First Address | Spokane, WA 99208-6289 |
Second Address | Spokane, WA 99208-6289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 17/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1039973 | (05) | WA |
A07514 | (02) | WA |