Provider Demographics
NPI:1902875099
Name:BRAUER, ALBERT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:DAVID
Last Name:BRAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36 KLONDIKE RD
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:WA
Mailing Address - Zip Code:99166-9701
Mailing Address - Country:US
Mailing Address - Phone:509-775-3153
Mailing Address - Fax:509-775-8929
Practice Address - Street 1:10 ROS CIR
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-5002
Practice Address - Country:US
Practice Address - Phone:509-775-3153
Practice Address - Fax:509-775-8929
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA21780207P00000X
WAMD00021780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1390905Medicaid
WA1390905Medicaid