Brackebusch, Mark C

Brackebusch, Mark C is an sole proprietor health care provider with primary practice located at 3900 Capitol Mall Dr Sw , Olympia WA 98502-8654. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Anesthesiology is his primary health care specialty. Brackebusch, Mark C can be contacted via phone (360) 754-5858.

Contact Information

Primary practice address
3900 Capitol Mall Dr Sw Olympia WA 98502-8654
Phone: (360) 754-5858
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X MD00025310 Washington
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X MD00025310 Washington

Profile Details

NPI number 1144272220
LBN Legal business name Brackebusch, Mark C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 16th, 2006
Last updated Jun 15th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144272220 NPPES
Washington MEDICAID 276507
Washington MEDICAID 210643
Washington MEDICAID 1054444

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