Provider Demographics
NPI:1235100306
Name:YOUNGGREN, BRADLEY NELS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:NELS
Last Name:YOUNGGREN
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:COMMANDER, MADIGAN ARMY MEDICAL CENTER
Mailing Address - Street 2:ATTN: MCHJ-EM
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-0596
Mailing Address - Fax:
Practice Address - Street 1:COMMANDER, MADIGAN ARMY MEDICAL CENTER
Practice Address - Street 2:ATTN: MCHJ-EM
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043623207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8887768Medicare PIN
WA8864613Medicare PIN