Basic Information
| Provider Information | |||||||||
| NPI: | 1255344958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOTT | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1535 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984011535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537614200 | ||||||||
| FaxNumber: | 2533833553 | ||||||||
| Practice Location | |||||||||
| Address1: | 1304 FAWCETT AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984021911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537614200 | ||||||||
| FaxNumber: | 2533833553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 05/15/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | MD00042337 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | MD00042337 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0212027 | 01 | WA | LABOR AND INDUSTRIES-UNION AVENUE OPEN MRI | OTHER | 8862660 | 01 | WA | MEDICARE PIN-UNION AVENUE OPEN MRI | OTHER | 8942261 | 01 | WA | LABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI | OTHER | 8942262 | 01 | WA | LABOR AND INDUSTRIES CRIME VICTIMS-TRA | OTHER | G8881778 | 01 | WA | PTAN-MIO1 | OTHER | P00375881 | 01 | WA | RR MEDICARE-TRA | OTHER | 0212026 | 01 | WA | LABOR AND INDUSTRIES-TRA | OTHER | 8862465 | 01 | WA | MEDICARE PIN-TRA KING | OTHER | 8951842 | 01 | WA | LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST | OTHER | 0249544 | 01 | WA | LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST | OTHER | 8862464 | 01 | WA | MEDICARE PIN-TRA PIERCE | OTHER |