Basic Information
| Provider Information | |||||||||
| NPI: | 1578828224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 W 8TH AVE STE 512C | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094653919 | ||||||||
| FaxNumber: | 5094680705 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 W 8TH AVE STE 512C | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094653919 | ||||||||
| FaxNumber: | 5095680705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2012 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OP60949997 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | OP60949997 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 208600000X | 5101019956 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 207RP1001X | OP60949997 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.