Healthcare Provider Details

I. General information

NPI: 1689114829
Provider Name (Legal Business Name): STEPHEN BRADY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-1610
US

IV. Provider business mailing address

9040 JACKSON AVE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-5509
  • Fax: 253-968-2608
Mailing address:
  • Phone: 253-968-5509
  • Fax: 253-968-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1863
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: