Provider Demographics
NPI:1144425299
Name:DARRELL C BRETT MD PC
Entity Type:Organization
Organization Name:DARRELL C BRETT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:BRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-253-4000
Mailing Address - Street 1:10000 SE MAIN #360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216
Mailing Address - Country:US
Mailing Address - Phone:503-253-4000
Mailing Address - Fax:503-253-3928
Practice Address - Street 1:10000 SE MAIN #360
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216
Practice Address - Country:US
Practice Address - Phone:503-253-4000
Practice Address - Fax:503-253-3928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR106086Medicare ID - Type Unspecified
R106086Medicare PIN