Healthcare Provider Details

I. General information

NPI: 1982922233
Provider Name (Legal Business Name): BRIAN N GIPSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 S MADELIA ST
SPOKANE WA
99223-6429
US

IV. Provider business mailing address

4407 S MADELIA ST
SPOKANE WA
99223-6429
US

V. Phone/Fax

Practice location:
  • Phone: 509-448-2692
  • Fax: 509-448-2692
Mailing address:
  • Phone: 509-448-2692
  • Fax: 509-448-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD00013661
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: