Doctor Name: | BRENT K EVETTS |
NPI Number: | 1538291547 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD20653 |
Business Practice Address: | 19875 Sw 65th Ave Suite 260 Tualatin, OR - 970628353 |
Business Phone Number: | 5036911743 |
Business Fax Number: | 5036910983 |
Mailing Address: | 19875 Sw 65th Ave, Suite 260 TUALATIN |
State: | OR |
Postal Code: | 970628353 |
Phone Number: | 5036911743 |
Fax Number: | 5036910983 |
NPI Enumeration Date: | 03/12/2007 |
NPI Last Update Date: | 07/29/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MD20653 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OR |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |