MEDICARE: BREANNA LOREEN PERCELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD151036	OR

General Provider Information

NPI Number	:	1225285109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA LOREEN PERCELL MD

Provider Business Mailing Address
First Line	:	PO BOX 670
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97709-0670
Country	:	US
Telephone Number	:	541-389-7741
Fax Number	:	541-278-8375

Provider Business Practice Location Address
First Line	:	2215 NW SHEVLIN PARK RD STE 100
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-7195
Country	:	US
Telephone Number	:	541-389-7741
Fax Number	:	541-278-8375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	03/22/2018

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Directions to “ BREANNA LOREEN PERCELL MD” Practice Location

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