Provider Demographics
NPI:1851686570
Name:DPMBECKMANNNROR LLC
Entity Type:Organization
Organization Name:DPMBECKMANNNROR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-990-7620
Mailing Address - Street 1:3760 MARKET ST NE
Mailing Address - Street 2:#105
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1826
Mailing Address - Country:US
Mailing Address - Phone:503-990-7620
Mailing Address - Fax:
Practice Address - Street 1:10435 SE CORA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2331
Practice Address - Country:US
Practice Address - Phone:503-760-1737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00434213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1952589996Medicare PIN