Provider Demographics
NPI:1679743876
Name:BRANDI S. MYERS DPM, LLC
Entity type:Organization
Organization Name:BRANDI S. MYERS DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-235-3315
Mailing Address - Street 1:7836 SE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6350
Mailing Address - Country:US
Mailing Address - Phone:503-235-8594
Mailing Address - Fax:503-235-3315
Practice Address - Street 1:7836 SE 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6350
Practice Address - Country:US
Practice Address - Phone:503-235-8594
Practice Address - Fax:503-235-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00355213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269549Medicaid
OR269549Medicaid
ORDE9781Medicare PIN
OR5326660001Medicare NSC
ORR121613Medicare PIN