Provider Demographics
NPI:1962184226
Name:BROTHERS, DONALD RAY III (PSS, BA, THW)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:RAY
Last Name:BROTHERS
Suffix:III
Gender:M
Credentials:PSS, BA, THW
Other - Prefix:
Other - First Name:EZRA
Other - Middle Name:JADEN
Other - Last Name:STERLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSS, BA, THW
Mailing Address - Street 1:1195 CITY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3325
Mailing Address - Country:US
Mailing Address - Phone:541-342-5088
Mailing Address - Fax:
Practice Address - Street 1:1195 CITY VIEW ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3325
Practice Address - Country:US
Practice Address - Phone:541-342-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000109085175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist