Healthcare Provider Details

I. General information

NPI: 1215975214
Provider Name (Legal Business Name): BRETT C CORBETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12442 SW SCHOLLS FERRY RD SUITE 106
TIGARD OR
97223-3396
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-9200
  • Fax: 503-216-9220
Mailing address:
  • Phone: 503-215-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD23050
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: