Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD22201 | OR |
N | 111NI0900X | Internist | MD22201 | OR |
Y | 207RC0000X | Internist - Cardiovascular Disease | MD22201 | OR |
NPI | 1003855065 |
---|---|
Provider Name | Dr. Randall V. Bream |
First Address | Corvallis, OR 97330-3737 |
Second Address | Corvallis, OR 97330-3737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 02/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130343 | (05) | OR |
A50117 | (02) | OR |