Individual
DR. BEVERLY ANN DE LA BRUERE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18151 SE HIGHWAY 212, DAMASCUS, OR 97089-8764
(503) 658-6022
(503) 658-7818
Mailing address
18151 SE HIGHWAY 212, DAMASCUS, OR 97089-8764
(503) 658-6022
(503) 658-7818
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
MD15031
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110403
—
OR
Enumeration date
10/10/2006
Last updated
08/02/2012
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