Provider Demographics
NPI:1851188411
Name:LAUER, BRYCEN MATTHEW (DO)
Entity type:Individual
Prefix:
First Name:BRYCEN
Middle Name:MATTHEW
Last Name:LAUER
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21651 OMAHA AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7240
Mailing Address - Country:US
Mailing Address - Phone:480-528-9166
Mailing Address - Fax:
Practice Address - Street 1:7201 W GRANDRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6709
Practice Address - Country:US
Practice Address - Phone:509-221-5520
Practice Address - Fax:509-221-5521
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADOL.OL.61683453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine