Provider Demographics
NPI:1821078080
Name:SAETRUM, BRENT B (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:B
Last Name:SAETRUM
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 1:10184 NE GARIBALDI LOOP
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:UT
Mailing Address - Zip Code:98110
Mailing Address - Country:US
Mailing Address - Phone:206-855-4778
Mailing Address - Fax:
Practice Address - Street 1:5000 HOPYARD ROAD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:WA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:925-251-6917
Practice Address - Fax:925-924-0506
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4994207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1164394-04Medicaid
TX8F9287OtherBC/BS PROVIDER NUMBER
TX930116427OtherRAILROAD MEDICARE PROV #
TX930116427OtherRAILROAD MEDICARE PROV #
TXB59707Medicare UPIN