Provider Demographics
NPI:1598831406
Name:ANDERSEN, BRAD L (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:L
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:22180 OLYMPIC COLLEGE WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6664
Mailing Address - Country:US
Mailing Address - Phone:360-394-3500
Mailing Address - Fax:360-394-3501
Practice Address - Street 1:22180 OLYMPIC COLLEGE WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6664
Practice Address - Country:US
Practice Address - Phone:360-394-3500
Practice Address - Fax:360-394-3501
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2011-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00034121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP000366802OtherRAILROAD MEDICARE
WA8247181Medicaid
WA8247181Medicaid
WAG8880227Medicare PIN