Provider Demographics
NPI:1447821343
Name:BRAR, SIMRANDEEP KAUR (MD)
Entity type:Individual
Prefix:
First Name:SIMRANDEEP
Middle Name:KAUR
Last Name:BRAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 DESERT PASS STREET
Mailing Address - Street 2:APARTMENT 1403
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3625
Mailing Address - Country:US
Mailing Address - Phone:915-273-9264
Mailing Address - Fax:
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2367
Practice Address - Country:US
Practice Address - Phone:360-501-3601
Practice Address - Fax:360-442-6843
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2024-05-13
Deactivation Date:2023-03-31
Deactivation Code:
Reactivation Date:2023-05-08
Provider Licenses
StateLicense IDTaxonomies
WAMD61463185207R00000X, 208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program