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NPI Code Detail

MEDICARE: DEVAN ROBERT LEAGUE

MEDICARE: DEVAN ROBERT LEAGUE
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
1175T00000XPeer Specialist114706OR
2175T00000XPeer Specialist24-CRM-3267OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18583307OTHERORODL

General Provider Information

NPI Number : 1750130290
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVAN ROBERT LEAGUE
Provider Business Mailing Address
First Line : 3425 13TH ST
Second Line :
City : BAKER CITY
State : OR
Zip : 97814-1340
Country : US
Telephone Number : 541-523-7400
Fax Number : 541-523-4927
Provider Business Practice Location Address
First Line : 3425 13TH ST
Second Line :
City : BAKER CITY
State : OR
Zip : 97814-1340
Country : US
Telephone Number : 541-523-7400
Fax Number : 541-523-4927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2024
Last Update Date : 02/10/2026

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Directions to “ DEVAN ROBERT LEAGUE ” Practice Location

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