Individual
DR. INDRAWAN HUSODO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
990 SYLVAN WAY, BREMERTON, WA 98310-2851
(360) 479-3657
(360) 373-7616
Mailing address
990 SYLVAN WAY, BREMERTON, WA 98310-2851
(360) 479-3657
(360) 373-7616
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD00028376
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050042796
RAILROAD MEDCIARE
WA
01
—
06487001
GROUP HEALTH CORP
WA
01
—
72669
LABOR AND INDUSTRIES
WA
05
—
8132292
—
WA
01
—
8933482
VICTIMS OF CRIME
WA
01
—
910847215
PREMERA BLUE CROSS
WA
01
—
91084721521
KPS
WA
01
—
HU0090
REGENCE BLUE SHIELD
WA
Enumeration date
07/08/2005
Last updated
01/21/2009
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