MEDICARE: DR. BRYNNE BERGSAGEL STANDAERT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	102241	MT

General Provider Information

NPI Number	:	1952395501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYNNE BERGSAGEL STANDAERT M.D.

Provider Business Mailing Address
First Line	:	1 BOONE RD
Second Line	:
City	:	BREMERTON
State	:	WA
Zip	:	98312-1894
Country	:	US
Telephone Number	:	360-475-4216
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BOONE RD
Second Line	:
City	:	BREMERTON
State	:	WA
Zip	:	98312-1894
Country	:	US
Telephone Number	:	360-475-4216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	01/26/2023

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