Basic Information
| Provider Information | |||||||||
| NPI: | 1699097279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAR | ||||||||
| FirstName: | PUSHAPDEEP | ||||||||
| MiddleName: | KAUR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 SE 164TH AVE DEPT 358 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986838004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607291253 | ||||||||
| FaxNumber: | 3607283185 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 9TH ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974397398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419978412 | ||||||||
| FaxNumber: | 5419021320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2010 | ||||||||
| LastUpdateDate: | 04/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD60607238 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD60607238 | WA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | MD180408 | OR | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | M13758 | ID | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MD180408 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 044664500 | 05 | MD | MEDICAID |