Healthcare Provider Details

I. General information

NPI: 1194746131
Provider Name (Legal Business Name): RONALD L BRAZG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 SW 10TH ST STE 250
RENTON WA
98057-5223
US

IV. Provider business mailing address

PO BOX 59028
RENTON WA
98058-2028
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4040
  • Fax: 425-656-4046
Mailing address:
  • Phone: 425-251-5110
  • Fax: 425-793-7458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD00027071
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: