Provider Demographics
NPI:1255344958
Name:KOTT, BRIAN RICHARD (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:RICHARD
Last Name:KOTT
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:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000423372085N0700X, 2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8862660OtherMEDICARE PIN-UNION AVENUE OPEN MRI
WA8951842OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WAP00375881OtherRR MEDICARE-TRA
WA8862464OtherMEDICARE PIN-TRA PIERCE
WA8862465OtherMEDICARE PIN-TRA KING
WA8942262OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WAG8881778OtherPTAN-MIO1
WA0212027OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA0212026OtherLABOR AND INDUSTRIES-TRA
WA0249544OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA8942261OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WAG8881778OtherPTAN-MIO1
WA8862465OtherMEDICARE PIN-TRA KING