Provider Demographics
NPI:1720168263
Name:BRILL, PETER WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WILLIAM
Last Name:BRILL
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 1:335 N.E. BLODGETT RD ANGELL JOB CORPS
Mailing Address - Street 2:
Mailing Address - City:YACHATS
Mailing Address - State:OR
Mailing Address - Zip Code:97498
Mailing Address - Country:US
Mailing Address - Phone:541-547-5629
Mailing Address - Fax:541-547-5691
Practice Address - Street 1:ANGELL JOB CORPS
Practice Address - Street 2:335 N.E. BLODGETT RD
Practice Address - City:YACHATS
Practice Address - State:OR
Practice Address - Zip Code:97498
Practice Address - Country:US
Practice Address - Phone:541-547-5629
Practice Address - Fax:541-547-5691
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24184207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A89713Medicare UPIN