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Individual

DEVAN ROBERT LEAGUE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
114706
OR
175T00000X
Peer Specialist
Primary
24-CRM-3267
OR
175T00000X
Peer Specialist
Primary
PENDING
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8583307
ODL
OR
Enumeration date
05/16/2024
Last updated
02/10/2026
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