Provider Demographics
NPI:1801842596
Name:WILL, BRIAN RALPH (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:RALPH
Last Name:WILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:9300 NE 177TH ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-6162
Mailing Address - Country:US
Mailing Address - Phone:360-573-6611
Mailing Address - Fax:360-449-0392
Practice Address - Street 1:8100 NE PARKWAY DR
Practice Address - Street 2:SUITE #125
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6742
Practice Address - Country:US
Practice Address - Phone:360-885-1327
Practice Address - Fax:360-449-0392
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00026277207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B85355Medicare UPIN