Provider Demographics
NPI:1588667323
Name:DEVRIES, BRENT C (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:C
Last Name:DEVRIES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 N MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1753
Mailing Address - Country:US
Mailing Address - Phone:419-842-3000
Mailing Address - Fax:419-842-3048
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3000
Practice Address - Fax:419-842-3048
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013263207RC0000X
OH34006461D207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2005403Medicaid
P00711892OtherRRMC
OH0826428Medicare PIN
OH0826427Medicare PIN
F92983Medicare UPIN
OK4010769Medicare PIN
OH7020751Medicare PIN
MIMI1635013Medicare PIN
OH4133511Medicare PIN
OH060060766Medicare PIN
MI23450015Medicare PIN
OH4010766Medicare PIN
P00711892OtherRRMC
OH4133512Medicare PIN
4133514Medicare PIN
OH4133515Medicare PIN
OH0826426Medicare PIN
OH0826424Medicare PIN
OH2005403Medicaid