Active NPI
Brent Packer, M.D.
- General Practice Physician
- Lacey, WA
National Provider Identifier
1902959018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- MD00033748
- Practice address
- 4220 Ingleside Dr SE
Lacey, WA 98503-2108 - Phone
- (360) 456-3429
- NPI assigned
- Jan 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | MD00033748 | WA | Primary |
Addresses
Primary practice location
4220 Ingleside Dr SE
Lacey, WA 98503-2108
Mailing address
4220 Ingleside Dr SE
Lacey, WA 98503-2108
Phone (360) 456-3429
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00033748 | WA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902959018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4220 INGLESIDE DR SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985032108",
"telephone_number": "360-456-3429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4220 INGLESIDE DR SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985032108",
"telephone_number": "360-456-3429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACKER",
"first_name": "BRENT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "WA",
"license": "MD00033748",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.