Individual
BRIAN LAVERENTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-0001
(706) 787-5811
Mailing address
9040 JACKSON AVE, TACOMA, WA 98431-0001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0102208192
VA
208D00000X
General Practice Physician
Primary
0102208192
VA
Other
Enumeration date
05/05/2022
Last updated
06/03/2026
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