Provider Demographics
NPI:1598822835
Name:BRETT, DARRELL CAMERON (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:CAMERON
Last Name:BRETT
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 1:10101 SE MAIN ST
Mailing Address - Street 2:1006
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2455
Mailing Address - Country:US
Mailing Address - Phone:503-253-4000
Mailing Address - Fax:503-253-4002
Practice Address - Street 1:10101 SE MAIN ST
Practice Address - Street 2:1006
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2455
Practice Address - Country:US
Practice Address - Phone:503-253-4000
Practice Address - Fax:503-253-4002
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR203117Medicaid
OR203117Medicaid
OR106087Medicare ID - Type Unspecified