Healthcare Provider Details

I. General information

NPI: 1366452765
Provider Name (Legal Business Name): P KAYE BRUNDIDGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CARILLON PT
KIRKLAND WA
98033-7306
US

IV. Provider business mailing address

1407A 33RD AVENUE
SEATTLE WA
98122
US

V. Phone/Fax

Practice location:
  • Phone: 425-576-1700
  • Fax: 425-650-9925
Mailing address:
  • Phone: 714-296-6377
  • Fax: 425-650-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00045181
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: