Individual
BROOKE KAIULANI WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1600 NE BROADWAY ST, PORTLAND, OR 97232-1426
(503) 963-3100
(503) 459-5398
Mailing address
847 NE 19TH AVE, SUITE 300, PORTLAND, OR 97232-2684
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
MD 60001443
WA
2084N0400X
Neurology Physician
Primary
MD151387
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1089540
—
WA
05
—
500628436
—
OR
Enumeration date
08/30/2006
Last updated
09/16/2013
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