Provider Demographics
NPI:1316994288
Name:BROCKENBROUGH, ANDREW TRUEMAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TRUEMAN
Last Name:BROCKENBROUGH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:STE 100
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4934
Mailing Address - Country:US
Mailing Address - Phone:425-656-5412
Mailing Address - Fax:425-656-4079
Practice Address - Street 1:24920 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6443
Practice Address - Country:US
Practice Address - Phone:425-690-3544
Practice Address - Fax:425-690-9444
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00039138207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1007639Medicaid
WAG8861625Medicare PIN