Healthcare Provider Details

I. General information

NPI: 1508779752
Provider Name (Legal Business Name): ANTHONY JAMES BREIMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 NE 82ND AVE STE 101
VANCOUVER WA
98662-6842
US

IV. Provider business mailing address

10505 W CLEARWATER AVE
KENNEWICK WA
99336-8613
US

V. Phone/Fax

Practice location:
  • Phone: 360-355-0805
  • Fax:
Mailing address:
  • Phone: 509-378-5553
  • Fax: 509-579-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: