Provider Demographics
NPI:1144388406
Name:BRAUN, FREDERIC HT (MD)
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:HT
Last Name:BRAUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1949
Mailing Address - Country:US
Mailing Address - Phone:360-733-3696
Mailing Address - Fax:360-733-9202
Practice Address - Street 1:3001 SQUALICUM PKWY
Practice Address - Street 2:SUITE 11
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1949
Practice Address - Country:US
Practice Address - Phone:360-733-3696
Practice Address - Fax:360-733-9202
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1041979Medicaid
WA1041979Medicaid