Provider Demographics
NPI:1396075149
Name:FREDERIC H.T. BRAUN, M.D. P.S.
Entity type:Organization
Organization Name:FREDERIC H.T. BRAUN, M.D. P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:HT
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-733-3696
Mailing Address - Street 1:1633 BIRCHWOOD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-9220
Mailing Address - Country:US
Mailing Address - Phone:360-733-3696
Mailing Address - Fax:360-733-9202
Practice Address - Street 1:1633 BIRCHWOOD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-9220
Practice Address - Country:US
Practice Address - Phone:360-733-3696
Practice Address - Fax:360-733-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1041979Medicaid
WA001400028Medicare PIN
WA1041979Medicaid