Healthcare Provider Details

I. General information

NPI: 1285716217
Provider Name (Legal Business Name): WILLIAM MARTIN BRUEGGEMANN MD00043830
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 NW CANAL BLVD
REDMOND OR
97756-1334
US

IV. Provider business mailing address

PO BOX 9787
YAKIMA WA
98909-0787
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-8131
  • Fax: 541-526-6608
Mailing address:
  • Phone: 509-574-3350
  • Fax: 509-225-3168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00043830
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: