Healthcare Provider Details

I. General information

NPI: 1215987342
Provider Name (Legal Business Name): DANIEL P BRUTOCAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

PO BOX 84301
SEATTLE WA
98124-5601
US

V. Phone/Fax

Practice location:
  • Phone: 509-926-1770
  • Fax: 509-228-9542
Mailing address:
  • Phone: 509-926-1770
  • Fax: 509-228-9542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00026787
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD00026787
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: