Provider Demographics
NPI:1730297573
Name:BRIM, STEWART PUGMIRE (DPM)
Entity Type:Individual
Prefix:MR
First Name:STEWART
Middle Name:PUGMIRE
Last Name:BRIM
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 1:12109 E BROADWAY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6133
Mailing Address - Country:US
Mailing Address - Phone:509-928-1990
Mailing Address - Fax:509-928-2933
Practice Address - Street 1:12109 E BROADWAY AVE STE C
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6133
Practice Address - Country:US
Practice Address - Phone:509-928-1990
Practice Address - Fax:509-928-2933
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO0000052213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7007933Medicaid
WA480019766OtherRAILROAD MEDICARE
WA1088178Medicaid
WA38665OtherLABOR AND INDUSTRIES
WA7007933Medicaid
U48237Medicare UPIN