Provider Demographics
NPI:1053505149
Name:LANCE D BRIGMAN, MD, PS
Entity Type:Organization
Organization Name:LANCE D BRIGMAN, MD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRIGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-423-6110
Mailing Address - Street 1:1004 FIR ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2527
Mailing Address - Country:US
Mailing Address - Phone:360-423-6110
Mailing Address - Fax:360-423-8078
Practice Address - Street 1:1004 FIR ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2527
Practice Address - Country:US
Practice Address - Phone:360-423-6110
Practice Address - Fax:360-423-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013785207Q00000X
WAMD000300532084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1104009Medicaid
WA1084862Medicaid
WA1084862Medicaid