Healthcare Provider Details

I. General information

NPI: 1053505149
Provider Name (Legal Business Name): LANCE D BRIGMAN, MD, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 FIR ST
LONGVIEW WA
98632-2527
US

IV. Provider business mailing address

1004 FIR ST
LONGVIEW WA
98632-2527
US

V. Phone/Fax

Practice location:
  • Phone: 360-423-6110
  • Fax: 360-423-8078
Mailing address:
  • Phone: 360-423-6110
  • Fax: 360-423-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00013785
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD00030053
License Number StateWA

VIII. Authorized Official

Name: LANCE D BRIGMAN
Title or Position: M.D.
Credential: M.D.
Phone: 360-423-6110