Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD28013 | OR |
N | 208600000X | Surgeon | MD28013 | OR |
Y | 2082S0105X | Plastic Hand Surgeon | MD | OR |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD28013 | OR |
NPI | 1205944782 |
---|---|
Provider Name | Brian Kreul |
First Address | Medford, OR 97504-7686 |
Second Address | Medford, OR 97504-8131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 13/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1205944782 | NPI (01) | OR |
R142382 | (02) | OR |