Healthcare Provider Details

I. General information

NPI: 1942511936
Provider Name (Legal Business Name): CHRISTOPHER JOHN BRUBAKER M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 EASTLAKE AVE E SUITE 120
SEATTLE WA
98102-3062
US

IV. Provider business mailing address

2825 EASTLAKE AVE E SUITE 120
SEATTLE WA
98102-3062
US

V. Phone/Fax

Practice location:
  • Phone: 206-486-4993
  • Fax: 206-535-6838
Mailing address:
  • Phone: 206-486-4993
  • Fax: 206-535-6838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60301735
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD60301735
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: