Individual
DAVID BROCKWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17455 SW 108TH PL, TUALATIN, OR 97062-8427
(503) 298-1935
Mailing address
17455 SW 108TH PL, TUALATIN, OR 97062-8427
(503) 298-1935
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DZ1386
—
OR
Enumeration date
10/16/2019
Last updated
10/16/2019
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