Provider Demographics
NPI:1336455146
Name:HANDLEY, BRIAN CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CRAIG
Last Name:HANDLEY
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:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:PACIFIC CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97135-0655
Mailing Address - Country:US
Mailing Address - Phone:503-965-6555
Mailing Address - Fax:503-965-6800
Practice Address - Street 1:1105 SE JETTY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-2632
Practice Address - Country:US
Practice Address - Phone:503-965-6555
Practice Address - Fax:503-965-6800
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD20166Medicare UPIN