Healthcare Provider Details

I. General information

NPI: 1679785109
Provider Name (Legal Business Name): SEYMOUR MAYNARD BRONSTEIN,P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W POPLAR
WALLA WALLA WA
99362
US

IV. Provider business mailing address

P O BOX 297
WALLA WALLA WA
99362
US

V. Phone/Fax

Practice location:
  • Phone: 509-522-5700
  • Fax:
Mailing address:
  • Phone: 509-525-2220
  • Fax: 509-525-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number9505
License Number StateND

VIII. Authorized Official

Name: SEYMOUR MAYNARD BRONSTEIN
Title or Position: OWNER
Credential: MD
Phone: 509-525-2220