Provider Demographics
NPI:1164580494
Name:MACLURG, BRIAN JASON (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JASON
Last Name:MACLURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:MACLURG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1120 CHERRY ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2023
Mailing Address - Country:US
Mailing Address - Phone:206-624-0296
Mailing Address - Fax:206-624-0296
Practice Address - Street 1:1120 CHERRY ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2023
Practice Address - Country:US
Practice Address - Phone:206-624-0296
Practice Address - Fax:206-624-0296
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000244692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1026178Medicaid
WA1813OtherLABOR AND INDUSTRY
WAMD00024469OtherMEDICAL LICENSE
WAAM3002615OtherDEA
WAA06204Medicare UPIN
WAMD00024469OtherMEDICAL LICENSE