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Individual

MR. DEVERY GERARD BRODDIE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
315 OAK ST. STE 200, HOOD RIVER, OR 97031
(541) 386-0009
(541) 386-0029
Mailing address
315 OAK ST, STE 200, HOOD RIVER, OR 97031
(541) 386-0009

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
225700000X
Massage Therapist
Primary
7291
OR
372600000X
Adult Companion

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1972649903
OR
Enumeration date
01/29/2007
Last updated
08/31/2020
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