Provider Demographics
NPI:1114362027
Name:LAY, BRIAN DAVID (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:LAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 3RD ST SE STE 240
Mailing Address - Street 2:MS 1322-2-EFM
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3771
Mailing Address - Country:US
Mailing Address - Phone:253-697-1420
Mailing Address - Fax:253-697-1439
Practice Address - Street 1:1322 3RD ST SE STE 240
Practice Address - Street 2:MS 1322-2-EFM
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3771
Practice Address - Country:US
Practice Address - Phone:253-697-1420
Practice Address - Fax:253-697-1439
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60669258207R00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program