Provider Demographics
NPI:1689700486
Name:MYERS, BRANDI SUE (DPM)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:SUE
Last Name:MYERS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 SE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4506
Mailing Address - Country:US
Mailing Address - Phone:503-235-8594
Mailing Address - Fax:503-235-3315
Practice Address - Street 1:5225 SE 28TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4506
Practice Address - Country:US
Practice Address - Phone:503-235-8594
Practice Address - Fax:503-235-3315
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00355213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269549Medicaid
ORV02246Medicare UPIN
OR269549Medicaid
OR5326660001Medicare NSC
ORP00329465Medicare PIN