Healthcare Provider Details

I. General information

NPI: 1720004229
Provider Name (Legal Business Name): BRANDT RAYMOND CULVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date: 10/30/2006
Reactivation Date: 11/17/2006

III. Provider practice location address

202 N DIVISION ST
AUBURN WA
98001-4939
US

IV. Provider business mailing address

15702 SE 178TH CT
RENTON WA
98058-9002
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7711
  • Fax:
Mailing address:
  • Phone: 916-201-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD174472
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA70840
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License NumberMD60591585
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: