Basic Information
| Provider Information | |||||||||
| NPI: | 1821078080 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAETRUM | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10184 NE GARIBALDI LOOP | ||||||||
| Address2: | |||||||||
| City: | BAINBRIDGE ISLAND | ||||||||
| State: | UT | ||||||||
| PostalCode: | 98110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068554778 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5000 HOPYARD ROAD | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 94588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252516917 | ||||||||
| FaxNumber: | 9259240506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207P00000X | K4994 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1164394-04 | 05 | TX | MEDICAID | 8F9287 | 01 | TX | BC/BS PROVIDER NUMBER | OTHER | 930116427 | 01 | TX | RAILROAD MEDICARE PROV # | OTHER |