Provider Demographics
NPI:1821096223
Name:NYQUIST, BRIAN O (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:O
Last Name:NYQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:990 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2851
Mailing Address - Country:US
Mailing Address - Phone:360-479-3657
Mailing Address - Fax:360-373-7616
Practice Address - Street 1:990 SYLVAN WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2851
Practice Address - Country:US
Practice Address - Phone:360-479-3657
Practice Address - Fax:360-373-7616
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024388207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA016487001OtherGROUP HEALTH CORP.
WA8284218Medicaid
WA016487001OtherVICTIMS OF CRIME
WA050082832OtherRAILROAD MEDICARE
WA910847215OtherPREMERA BLUE CROSS
WA0152285OtherLABOR AND INDUSTRIES
WA91084721532OtherKPS
WA7215NYOtherREGENCE BLUE SHIELD
WAA029OtherTRIWEST
WA910847215OtherUNIFORM MEDICAL
WA7215NYOtherREGENCE BLUE SHIELD
WA050082832OtherRAILROAD MEDICARE