MEDICARE: DR. BRETT REID DEGOOYER D.O.

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	207QS0010X	Sports Medicine (Family Medicine) Physician	OP60081051	WA
2	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	OP60081051	WA

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

General Provider Information

NPI Number	:	1568477354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT REID DEGOOYER D.O.

Provider Business Mailing Address
First Line	:	1616 S PIONEER WAY
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-2487
Country	:	US
Telephone Number	:	509-793-9715
Fax Number	:	509-764-3244

Provider Business Practice Location Address
First Line	:	1550 S PIONEER WAY STE 350
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-4618
Country	:	US
Telephone Number	:	509-793-9789
Fax Number	:	509-764-3266

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	05/04/2026

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