1912713520 NPI number — RICHARD ALAN BRYANT SUDPT

Table of content: RICHARD ALAN BRYANT SUDPT (NPI 1912713520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912713520 NPI number — RICHARD ALAN BRYANT SUDPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYANT
Provider First Name:
RICHARD
Provider Middle Name:
ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SUDPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912713520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 950 WENATCHEE, WA 98807
Provider Second Line Business Mailing Address:
327 OKANOGAN AVE
Provider Business Mailing Address City Name:
WENATCHEE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-662-9673
Provider Business Mailing Address Fax Number:
509-662-9441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 OKANOGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-662-9673
Provider Business Practice Location Address Fax Number:
509-662-9441
Provider Enumeration Date:
12/09/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CO61622638 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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