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General NPI Number Information
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NPI Number | 1821432840
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Entity Type | Individual
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Provider Name | BRIAN MATTHEW CORLISS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/21/2013
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-5001
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Country | US
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Telephone | 253-968-4945
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Fax |
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Provider Business Mailing Address
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Address Line | 10430 90TH AVE SW
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City | LAKEWOOD
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State | WA
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Zip | 98498-3719
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Country | US
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Telephone | 518-588-6863
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | MD61563557
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License Number State | WA
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