Basic Information
| Provider Information | |||||||||
| NPI: | 1205802824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRINGGOLD | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6220 CAPE GEORGE RD | ||||||||
| Address2: | |||||||||
| City: | PORT TOWNSEND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983689040 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 939 CAROLINE ST | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983623997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604177000 | ||||||||
| FaxNumber: | 3604525772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00033625 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | MD00033625 | WA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.