Healthcare Provider Details

I. General information

NPI: 1740143239
Provider Name (Legal Business Name): BRANDON MICHAEL LAMBETH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W SPERRY STREET
HEPPNER OR
97836
US

IV. Provider business mailing address

550 W SPERRY STREET
HEPPNER OR
97836
US

V. Phone/Fax

Practice location:
  • Phone: 541-676-9161
  • Fax: 541-676-5662
Mailing address:
  • Phone: 541-676-9161
  • Fax: 541-676-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: