Healthcare Provider Details

I. General information

NPI: 1740009430
Provider Name (Legal Business Name): TYLER SEAN BEGOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 SW 30TH ST
CORVALLIS OR
97331-8629
US

IV. Provider business mailing address

845 SW 30TH ST
CORVALLIS OR
97331-8629
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-7700
  • Fax:
Mailing address:
  • Phone: 541-768-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number7248400453
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: