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1285674499

NPI Code Detail

MEDICARE: SANDRA CAROL BROEREN MD

MEDICARE: SANDRA CAROL BROEREN 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	207R00000X	Internal Medicine Physician	26866	AL
2	207Q00000X	Family Medicine Physician	MD157517	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	051529785	OTHER	AL	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	051529786	OTHER	AL	BLUE CROSS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	051529784	OTHER	AL	BLUE CROSS
8	051529787	OTHER	AL	BLUE CROSS

General Provider Information

NPI Number	:	1285674499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA CAROL BROEREN MD

Provider Business Mailing Address
First Line	:	17055 RUBEN LN
Second Line	:
City	:	SANDY
State	:	OR
Zip	:	97055-9276
Country	:	US
Telephone Number	:	503-668-8002
Fax Number	:	503-668-5246

Provider Business Practice Location Address
First Line	:	17055 RUBEN LN
Second Line	:
City	:	SANDY
State	:	OR
Zip	:	97055-9276
Country	:	US
Telephone Number	:	503-668-8002
Fax Number	:	503-668-5246

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	03/17/2018

Similar Medicare Providers

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Practice Location Address:

17055 RUBEN LN
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97055-9276

Practice Phone: 503-668-8002
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1053346072 — DR. MICHAEL PINN M.D.
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97055-9276

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1477565026 — MR. WILLIAM ANTHONY GROMKO M.D.
Practice Location Address:

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SANDY, OR
97055-9276

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1023171725 — ELIZABETH JOYCE PACARRO APRN
Practice Location Address:

17055 RUBEN LN
SANDY, OR
97055-9276

Practice Phone: 503-668-8002
Practice Fax: 503-668-5246

1427253111 — JONNA HOBBS FNP
Practice Location Address:

17055 RUBEN LN
SANDY, OR
97055-9276

Practice Phone: 503-668-8002
Practice Fax: 503-668-5246

1538330816 — MRS. CLAUDIA M PETERSON FNP
Practice Location Address:

17055 RUBEN LN
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97055-9276

Practice Phone: 503-668-8002
Practice Fax: 503-668-5246

Directions to “ SANDRA CAROL BROEREN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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