Healthcare Provider Details

I. General information

NPI: 1265612071
Provider Name (Legal Business Name): DEVIN J. BRANSTETTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-4402
US

IV. Provider business mailing address

9040 JACKSON AVE
TACOMA WA
98431-1326
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2240
  • Fax:
Mailing address:
  • Phone: 253-968-2235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD60085548
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number60085548
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: