Healthcare Provider Details

I. General information

NPI: 1245301241
Provider Name (Legal Business Name): RICHARD J. BREUNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MADISON ST STE 100
SEATTLE WA
98104-1316
US

IV. Provider business mailing address

PO BOX 84026
SEATTLE WA
98124-8426
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6111
  • Fax: 206-386-6113
Mailing address:
  • Phone: 206-386-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00027092
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00027092
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: