Provider Demographics
NPI:1639664386
Name:VOLPER, BRENT DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:DAVID
Last Name:VOLPER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16701 SE MCGILLIVRAY BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3462
Mailing Address - Country:US
Mailing Address - Phone:360-834-3707
Mailing Address - Fax:360-834-3569
Practice Address - Street 1:16701 SE MCGILLIVRAY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-3462
Practice Address - Country:US
Practice Address - Phone:360-834-3707
Practice Address - Fax:360-834-3569
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO61338750213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty