Provider Demographics
NPI:1689651952
Name:BRANDT, REBECCA C (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:BRANDT
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 1:5101 BRENNER RD NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1534
Mailing Address - Country:US
Mailing Address - Phone:360-915-6276
Mailing Address - Fax:
Practice Address - Street 1:5101 BRENNER RD NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1534
Practice Address - Country:US
Practice Address - Phone:360-915-6276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3016402Medicaid
IA5016402Medicaid
IA6016402Medicaid
IA7016402Medicaid
IA9016402Medicaid
IA0421834Medicaid
IA8016402Medicaid
IA8016402Medicaid
IAA02957Medicare UPIN