Provider Demographics
NPI:1043507973
Name:THIELGES, BRENT JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JAMES
Last Name:THIELGES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9613 SANDIFUR PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8028
Mailing Address - Country:US
Mailing Address - Phone:509-591-9454
Mailing Address - Fax:509-578-1118
Practice Address - Street 1:9613 SANDIFUR PKWY STE B
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8028
Practice Address - Country:US
Practice Address - Phone:509-591-9454
Practice Address - Fax:509-578-1118
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60436994213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035708Medicaid
WA2035708Medicaid