Basic Information
| Provider Information | |||||||||
| NPI: | 1396993085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHER | ||||||||
| FirstName: | BRENT | ||||||||
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| Credential: | RPA, RRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 HARLOW RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974771346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416818586 | ||||||||
| FaxNumber: | 5416818587 | ||||||||
| Practice Location | |||||||||
| Address1: | 1255 HILYARD ST | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416877134 | ||||||||
| FaxNumber: | 5416877135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2008 | ||||||||
| LastUpdateDate: | 04/11/2013 | ||||||||
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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 | 243U00000X | 103085 | OR | Y | Technologists, Technicians & Other Technical Service Providers | Radiology Practitioner Assistant |
No ID Information.