DR. BEVERLY ANN DE LA BRUERE NPI 1720176332

NPI Information

NPI: 1720176332
Provider Name: DR. BEVERLY ANN DE LA BRUERE
Classification: Family Medicine - 207QA0401X
Entity Type: Individual

Specialization: Addiction Medicine

CLIA Number: 38D0621790

Address:
18151 SE HIGHWAY 212
DAMASCUS, OR
ZIP 97089
Phone: (503) 658-6022
Get Directions

DR. Beverly Ann De La Bruere is an addiction medicine family medicine in Damascus, OR. The provider is a family medicine physician who specializes in the diagnosis and treatment of addictions. DR. Beverly Ann De La Bruere NPI is 1720176332. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

18151 SE HIGHWAY 212
DAMASCUS, OR
ZIP 97089-764
Phone: (503) 658-6022
Fax: (503) 658-7818

The CLIA number assigned to this NPI record is 38D0621790 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/10/2006 and was last updated on 8/2/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207QA0401X	Family Medicine	Addiction Medicine	MD15031	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	C92493	MEDICARE UPIN	OREGON
2	R0000BHXVZ	MEDICARE ID-TYPE UNSPECIFIED	OREGON
3	110403	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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