Basic Information
| Provider Information | |||||||||
| NPI: | 1518042316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREMNER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50095 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981455095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065436420 | ||||||||
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| Practice Location | |||||||||
| Address1: | MEDICAL SPECIALTIES-ENDOCRINE CLIN | ||||||||
| Address2: | 1959 NE PACIFIC STREET | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981956166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065984615 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 01/24/2012 | ||||||||
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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 | 207R00000X | MD00016365 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | MD00016365 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 0230858 | 01 | WA | L&I | OTHER | 1518042316 | 05 | WA | MEDICAID | 1628 | 01 | INTERNAL ID-MOTOR VEHICLE ID | OTHER |