Provider Demographics
NPI:1710073200
Name:APPLEBAUM, BRIAN ALEC (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALEC
Last Name:APPLEBAUM
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 1:541 NE 20TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2895
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:1508 DIVISION ST STE 15
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1583
Practice Address - Country:US
Practice Address - Phone:503-692-3750
Practice Address - Fax:503-691-2324
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27143207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1710073200Medicaid
OR213073Medicaid
ORI69387Medicare UPIN
OR213073Medicaid
WA1710073200Medicaid
OR171901Medicare PIN