Provider Demographics
NPI:1366452765
Name:BRUNDIDGE, P KAYE (MD)
Entity Type:Individual
Prefix:
First Name:P
Middle Name:KAYE
Last Name:BRUNDIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407A 33RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:714-296-6377
Mailing Address - Fax:425-650-9925
Practice Address - Street 1:3100 CARILLON PT
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7306
Practice Address - Country:US
Practice Address - Phone:425-576-1700
Practice Address - Fax:425-650-9925
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045181207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8430720Medicaid
WAG8923419OtherNORIDIAN PTAN
E82824Medicare UPIN
G8861869Medicare PIN