Provider Demographics
NPI:1285958892
Name:SUNDQUIST, BRIAN CLYDE
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CLYDE
Last Name:SUNDQUIST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9636
Mailing Address - Country:US
Mailing Address - Phone:509-422-7409
Mailing Address - Fax:509-422-7471
Practice Address - Street 1:617 BENTON ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9636
Practice Address - Country:US
Practice Address - Phone:509-422-7409
Practice Address - Fax:509-422-7471
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology