Provider Demographics
NPI:1942519046
Name:BRANHAM, JOSHUA PAUL (PAC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:PAUL
Last Name:BRANHAM
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 12TH AVE S STE 901
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2712
Mailing Address - Country:US
Mailing Address - Phone:206-548-3058
Mailing Address - Fax:206-262-0859
Practice Address - Street 1:12721 30TH AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4498
Practice Address - Country:US
Practice Address - Phone:206-417-0326
Practice Address - Fax:206-417-0783
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014025050363AM0700X
WAPA61138779363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical