Basic Information
| Provider Information | |||||||||
| NPI: | 1972687788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRASCH | ||||||||
| FirstName: | ROBERT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34509 9TH AVE S STE 204 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538355510 | ||||||||
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| Practice Location | |||||||||
| Address1: | 34509 9TH AVE S STE 204 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538355510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 207050 | NY | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD60864173 | WA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 01943553 | 05 | NY | MEDICAID | 2120876 | 05 | WA | MEDICAID |