Basic Information
| Provider Information | |||||||||
| NPI: | 1306131032 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DPMBECKMANNNROR LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3760 MARKET ST NE | ||||||||
| Address2: | #105 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973011826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039907620 | ||||||||
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| Practice Location | |||||||||
| Address1: | 835 CRATER LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975046505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417737717 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2011 | ||||||||
| LastUpdateDate: | 06/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | BECKMANN | ||||||||
| AuthorizedOfficialFirstName: | BROOKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5039907620 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | DP00434 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
No ID Information.