Provider Demographics
NPI:1720004229
Name:CULVER, BRANDT RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDT
Middle Name:RAYMOND
Last Name:CULVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15702 SE 178TH CT
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9002
Mailing Address - Country:US
Mailing Address - Phone:916-201-6558
Mailing Address - Fax:
Practice Address - Street 1:202 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:253-833-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-07-05
Deactivation Date:2006-10-30
Deactivation Code:
Reactivation Date:2006-11-17
Provider Licenses
StateLicense IDTaxonomies
ORMD174472207L00000X
CAA70840207L00000X
WAMD60591585207LH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500702845Medicaid
H68305Medicare UPIN
ORR186167Medicare PIN