Provider Demographics
NPI:1871596346
Name:BARSTAD, BRIAN K (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:BARSTAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:4804 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2119
Practice Address - Country:US
Practice Address - Phone:509-942-2355
Practice Address - Fax:509-222-1289
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60310747207PE0004X, 207Q00000X
MN42142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN123492700Medicaid
MN080010584Medicare ID - Type Unspecified
MNH08430Medicare UPIN
MN123492700Medicaid