Healthcare Provider Details

I. General information

NPI: 1588764344
Provider Name (Legal Business Name): MICHAEL C. BRIED PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DEYE LANE
EASTSOUND WA
98245-1269
US

IV. Provider business mailing address

PO BOX 114
EASTSOUND WA
98245-0114
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-2561
  • Fax: 360-376-5183
Mailing address:
  • Phone: 360-376-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10003670
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: