Provider Demographics
NPI:1003855065
Name:BREAM, RANDALL V (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:V
Last Name:BREAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 NW SAMARITAN DR
Mailing Address - Street 2:SUITE E350
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3737
Mailing Address - Country:US
Mailing Address - Phone:541-768-5205
Mailing Address - Fax:541-768-5206
Practice Address - Street 1:3600 NW SAMARITAN DR
Practice Address - Street 2:SUITE E350
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3737
Practice Address - Country:US
Practice Address - Phone:541-768-5205
Practice Address - Fax:541-768-5206
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22201207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130343Medicaid
ORA50117Medicare UPIN
OR130343Medicaid