MEDICARE: BEAVERTON NATUROPATHIC MEDICINE

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	175F00000X	Naturopath	0704	OR

General Provider Information

NPI Number	:	1407029457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVERTON NATUROPATHIC MEDICINE

Provider Business Mailing Address
First Line	:	4085 SW 109TH AVE
Second Line	:	SUITE 200
City	:	BEAVERTON
State	:	OR
Zip	:	97005-3000
Country	:	US
Telephone Number	:	503-643-1024
Fax Number	:

Provider Business Practice Location Address
First Line	:	4085 SW 109TH AVE
Second Line	:	SUITE 200
City	:	BEAVERTON
State	:	OR
Zip	:	97005-3000
Country	:	US
Telephone Number	:	503-643-1024
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUDY EVELYN PEABODY
Credential	:	N.D.
Telephone Number	:	503-643-1024

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	04/10/2008

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