Brottem, John Leonard

Brottem, John Leonard is an individual health care provider with primary practice located at 500 Lilly Rd Ne , Olympia WA 98506-5197. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Brottem, John Leonard can be contacted via phone (360) 413-8272.

Contact Information

Primary practice address
500 Lilly Rd Ne Olympia WA 98506-5197
Fax: (360) 413-8878
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X MD00018177 Washington

Profile Details

NPI number 1972566818
LBN Legal business name Brottem, John Leonard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 11th, 2006
Last updated Jul 9th, 2007 - about 18 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972566818 NPPES
Washington MEDICAID 8214801

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