Provider Demographics
NPI:1306052287
Name:JEWETT, BRIAN CHRISTOPHER (LMP)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:JEWETT
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14802 NE 31ST CIR
Mailing Address - Street 2:BLDG. A,SUITE N
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5321
Mailing Address - Country:US
Mailing Address - Phone:425-869-2882
Mailing Address - Fax:425-869-0368
Practice Address - Street 1:14802 NE 31ST CIR
Practice Address - Street 2:BLDG. A,SUITE N
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5321
Practice Address - Country:US
Practice Address - Phone:425-869-2882
Practice Address - Fax:425-869-0368
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021909305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization