Provider Demographics
NPI:1164431680
Name:FREY, BRUCE E (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:FREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-0670
Mailing Address - Country:US
Mailing Address - Phone:541-768-5227
Mailing Address - Fax:541-768-5303
Practice Address - Street 1:501 NW ELKS DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3757
Practice Address - Country:US
Practice Address - Phone:541-768-5220
Practice Address - Fax:541-768-5303
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD162792085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR060033Medicaid
F42315Medicare UPIN
OR060033Medicaid