Healthcare Provider Details

I. General information

NPI: 1194732552
Provider Name (Legal Business Name): BRIAN GUMBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 SKYLINE RD S KAISER PERMANENTE
SALEM OR
97306-9427
US

IV. Provider business mailing address

5125 SKYLINE RD S KAISER PERMANENTE
SALEM OR
97306-9427
US

V. Phone/Fax

Practice location:
  • Phone: 503-361-5400
  • Fax: 503-315-4668
Mailing address:
  • Phone: 503-361-5400
  • Fax: 503-315-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD26607
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: