Provider Demographics
NPI:1235131590
Name:BRIGMAN, LANCE DEE (MD)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:DEE
Last Name:BRIGMAN
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 1:1004 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
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1104009Medicaid
WA0014232OtherL & I
WA0014232OtherL & I
WAAB09603Medicare ID - Type Unspecified