Individual
DANIEL BROCKSMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
315 MARTIN LUTHER KING JR WAY, MS: 315-J1-TRM, TACOMA, WA 98405-4234
(253) 403-7537
(253) 403-7539
Mailing address
PO BOX 5299, MS: 315-J1-RTM, TACOMA, WA 98415-0299
(253) 403-7537
(253) 403-7539
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
52770
CA
363AS0400X
Surgical Physician Assistant
Primary
PA10004008
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191330
DEPT OF L&I PIN
WA
01
—
8160BR
REGENCE PIN
WA
05
—
8408346
—
WA
01
—
8939391
CRIME VICTIMS COMP PIN
WA
Enumeration date
07/13/2006
Last updated
10/09/2020
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