Provider Demographics
NPI:1285720631
Name:GASS, BROOKE R (MD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:R
Last Name:GASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22409 SW NEWLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9720
Mailing Address - Country:US
Mailing Address - Phone:503-638-6192
Mailing Address - Fax:
Practice Address - Street 1:KAISER SUNNYSIDE MEDICAL CENTER
Practice Address - Street 2:10180 SE SUNNYSIDE ROAD
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9764
Practice Address - Country:US
Practice Address - Phone:503-652-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18048208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics