Individual
BRENDAN HAUGHIE JACKSON-FOWL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1401 MADISON ST STE 100, SEATTLE, WA 98104-1316
(206) 386-6111
(206) 386-6113
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 386-6111
(206) 386-6113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP61295493
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2208498
—
WA
Enumeration date
04/27/2022
Last updated
02/10/2026
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