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NPI Code Detail

MEDICARE: DPMBECKMANNNROR LLC

MEDICARE: DPMBECKMANNNROR LLC
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
1213EP1101XPrimary Podiatric Medicine PodiatristDP00434OR

General Provider Information

NPI Number : 1588959209
Entity Type Code : Organization
Provider Name (Legal Business Name) : DPMBECKMANNNROR LLC
Provider Business Mailing Address
First Line : 3760 MARKET ST NE
Second Line : #105
City : SALEM
State : OR
Zip : 97301-1826
Country : US
Telephone Number : 503-990-7620
Fax Number :
Provider Business Practice Location Address
First Line : 835 SW 11TH ST
Second Line :
City : NEWPORT
State : OR
Zip : 97365-4802
Country : US
Telephone Number : 541-265-5356
Fax Number :
Authorized Official
Title or Position : OWNER
Name : BROOKE BECKMANN
Credential : DPM
Telephone Number : 503-990-7620
Provider Enumeration Date : 06/10/2011
Last Update Date : 06/10/2011

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Directions to “DPMBECKMANNNROR LLC ” Practice Location

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