Provider Demographics
NPI:1245287499
Name:BRASETH, ARIN T (MD)
Entity type:Individual
Prefix:DR
First Name:ARIN
Middle Name:T
Last Name:BRASETH
Suffix:
Gender:F
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:PO BOX 5007
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-5007
Mailing Address - Country:US
Mailing Address - Phone:800-599-0166
Mailing Address - Fax:
Practice Address - Street 1:413 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5133
Practice Address - Country:US
Practice Address - Phone:360-491-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040876207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00148542OtherRAILROAD MEDICARE
WA8295743Medicaid
4758BROtherREGENCE BS
0186412OtherWA L & I
8938285OtherWA CRIME VICTIMS
H62171OtherGROUP HEALTH
H62171OtherGROUP HEALTH
G8803849Medicare PIN