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Individual

BRAD GOLDWORM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.

Contact information

Practice address
2950 LIMITED LN NW, OLYMPIA, WA 98502-4577
(360) 252-9777
Mailing address
PO BOX 34584, SEATTLE, WA 98124-1584
(509) 241-7349
(509) 241-7628

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10004755
WA
363AM0700X
Medical Physician Assistant
Primary
PA10004755
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8446841
WA
Enumeration date
01/22/2007
Last updated
01/07/2021
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