Provider Demographics
NPI:1285881441
Name:GOERTZ, BRIAN O (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:O
Last Name:GOERTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11007 SLATER AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4605
Mailing Address - Country:US
Mailing Address - Phone:425-454-4214
Mailing Address - Fax:
Practice Address - Street 1:11007 SLATER AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4605
Practice Address - Country:US
Practice Address - Phone:425-454-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026686204F00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine