Provider Demographics
NPI:1952589996
Name:BECKMANN, BROOKE ROBERT (DPM)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ROBERT
Last Name:BECKMANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 MARKET ST NE # 105
Mailing Address - Street 2:
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 1:3760 MARKET ST NE # 105
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1826
Practice Address - Country:US
Practice Address - Phone:503-990-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00434213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1952589996Medicare NSC
ORR147274Medicare PIN
ORR143277Medicare PIN
ORR143278Medicare PIN