Healthcare Provider Details

I. General information

NPI: 1639382302
Provider Name (Legal Business Name): RYAN PATRICK BREDEWEG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 FAWCETT AVE STE 100
TACOMA WA
98402-1900
US

IV. Provider business mailing address

1304 FAWCETT AVE STE 100
TACOMA WA
98402-1900
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-4200
  • Fax:
Mailing address:
  • Phone: 253-761-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD60149277
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301088522
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD60149277
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: