Provider Demographics
NPI:1639146285
Name:PADRTA, BRIAN J (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:PADRTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 W 5TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2715
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:212 E CENTRAL AVE
Practice Address - Street 2:STE 140
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6289
Practice Address - Country:US
Practice Address - Phone:509-465-1300
Practice Address - Fax:509-465-1313
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00032721207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010004369OtherREGENCE BLUE SHIELD OF ID
IDK6443OtherBLUE CROSS OF IDAHO
WAPA6715OtherASURIS NW HEALTH
WA100723OtherDEPT OF LABOR & INDUSTRIE
WA8940287OtherCRIME VICTIMES
WA1094937Medicaid
WA6512OtherGROUP HEALTH NW
WA1094937Medicaid