Basic Information
Provider Information
NPI: 1033556873
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRELSFORD
FirstName: DANIEL
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 34876
Address2:  
City: SEATTLE
State: WA
PostalCode: 981241876
CountryCode: US
TelephoneNumber: 4256565412
FaxNumber: 4256564096
Practice Location
Address1: 3901 NE 4TH ST
Address2: STE 105
City: RENTON
State: WA
PostalCode: 980564100
CountryCode: US
TelephoneNumber: 4256565500
FaxNumber: 4256565542
Other Information
ProviderEnumerationDate: 06/03/2013
LastUpdateDate: 10/11/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD60688559WAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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