Individual
JOHN J BRANDABUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 W 8TH AVE STE 7050, SPOKANE, WA 99204-2362
(509) 252-1711
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD00023333
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0030011
LABOR & INDUSTRY
WA
01
—
100005788
RAILROAD MEDICARE
—
05
—
1031699
—
WA
01
—
806364300
IDAHO MEDICAID
WA
01
—
8890442
MEDICARE PTAN - SNO CO
WA
01
—
BR7060
BLUE SHIELD
WA
01
—
MD336WA
ALASKA MEDICAID
WA
01
—
US0818959
AETNA/USHC PCP
WA
01
—
US4217189
AETNA/USHC PCP
WA
Enumeration date
07/05/2006
Last updated
02/10/2023
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