Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | OP60081051 | WA |
N | 207QS0010X | Family Doctor - Sports Medicine | OP60081051 | WA |
NPI | 1568477354 |
---|---|
Provider Name | Dr. Brett Reid Degooyer |
First Address | Moses Lake, WA 98837-1872 |
Second Address | Moses Lake, WA 98837-4618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 27/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2114835 | (05) | WA |