Basic Information
| Provider Information | |||||||||
| NPI: | 1639146285 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PADRTA | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W 5TH AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093442663 | ||||||||
| FaxNumber: | 5096249179 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 E CENTRAL AVE | ||||||||
| Address2: | STE 140 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992086289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094651300 | ||||||||
| FaxNumber: | 5094651313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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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 | 207XX0004X | MD00032721 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000010004369 | 01 | ID | REGENCE BLUE SHIELD OF ID | OTHER | K6443 | 01 | ID | BLUE CROSS OF IDAHO | OTHER | PA6715 | 01 | WA | ASURIS NW HEALTH | OTHER | 100723 | 01 | WA | DEPT OF LABOR & INDUSTRIE | OTHER | 8940287 | 01 | WA | CRIME VICTIMES | OTHER | 1094937 | 05 | WA | MEDICAID | 6512 | 01 | WA | GROUP HEALTH NW | OTHER |