Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 25552 | OR |
NPI | 1003915869 |
---|---|
Provider Name | Brett W Mikeska |
First Address | Salem, OR 97301-3975 |
Second Address | Salem, OR 97301-3975 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 31/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023097 | (05) | OR |
H77190 | (02) | OR |