Basic Information
| Provider Information | |||||||||
| NPI: | 1376653790 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | BRETT | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1474 | ||||||||
| Address2: | |||||||||
| City: | FORT BENTON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594421474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066225955 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1775 THOMPSON RD | ||||||||
| Address2: | |||||||||
| City: | COOS BAY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412948086 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 8382 | MT | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | DO159936 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.