Provider Demographics
NPI:1467449967
Name:ROWE, BRENT J (MD)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:J
Last Name:ROWE
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 1:954 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1001
Mailing Address - Country:US
Mailing Address - Phone:360-532-1360
Mailing Address - Fax:360-532-6878
Practice Address - Street 1:954 ANDERSON DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1001
Practice Address - Country:US
Practice Address - Phone:360-532-1360
Practice Address - Fax:360-532-6878
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038372208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1111574Medicaid
1126R0OtherREGENCE WA
WA140415OtherDEPT OF L & I
WA140415OtherDEPT OF L & I
1126R0OtherREGENCE WA