Provider Demographics
NPI:1467476606
Name:BROGREN, JULIE K (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:BROGREN
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:PO BOX 47148
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-7148
Mailing Address - Country:US
Mailing Address - Phone:206-932-9025
Mailing Address - Fax:
Practice Address - Street 1:4410 106TH ST SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4700
Practice Address - Country:US
Practice Address - Phone:425-493-6004
Practice Address - Fax:425-493-6014
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1011087Medicaid
WAI04023Medicare UPIN
WAG8948919Medicare PIN