=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306411921
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DALLIN BROWNELL DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2021
-----------------------------------------------------
Last Update Date | 07/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9605 SANDIFUR PKWY
-----------------------------------------------------
City | PASCO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99301-8028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-942-3170
-----------------------------------------------------
Fax | 509-543-9795
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 GAGE BLVD STE 101
-----------------------------------------------------
City | RICHLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99352-9532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-473-0637
-----------------------------------------------------
Fax | 509-627-2983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OP61559679
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------