Provider Demographics
NPI:1497105811
Name:GUDGEL, BRETT MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:MATTHEW
Last Name:GUDGEL
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 1:1306 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1523
Mailing Address - Country:US
Mailing Address - Phone:918-640-2948
Mailing Address - Fax:
Practice Address - Street 1:1306 DIVISION ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1523
Practice Address - Country:US
Practice Address - Phone:503-656-4221
Practice Address - Fax:503-656-4249
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11685097-1205207W00000X
OK32820207W00000X
IN11018880A390200000X
ORMD205372207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR227471OtherMEDICARE
OR500794640Medicaid