Brocksmith, Daniel
Brocksmith, Daniel is an individual health care provider with primary practice located at 315 Martin Luther King Jr Way Ms: 315-J1-Trm, Tacoma WA 98405-4234. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Brocksmith, Daniel can be contacted via phone (253) 403-7537.Contact Information
Primary practice address
315 Martin Luther King Jr Way Ms: 315-J1-Trm
Tacoma WA 98405-4234
Phone: (253) 403-7537
Fax: (253) 403-7539
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Surgical | 363AS0400X | 52770 | California |
| Physician Assistants & Advanced Practice Nursing Providers / Surgical | 363AS0400X | PA10004008 | Washington |
Profile Details
| NPI number | 1114942554 |
|---|---|
| LBN Legal business name | Brocksmith, Daniel |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 13th, 2006 |
| Last updated | Oct 9th, 2020 - about 5 years ago |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114942554 | NPPES |
| Washington | Other | 8160BR | REGENCE PIN |
| Washington | Other | 8939391 | REGENCE PIN |
| Washington | Other | 191330 | REGENCE PIN |
| Washington | MEDICAID | 8408346 | REGENCE PIN |
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