Healthcare Provider Details

I. General information

NPI: 1912433772
Provider Name (Legal Business Name): LAUREN JAVERNICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN BOMBARDIER

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 08/19/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 SW GRANDVIEW AVENUE SUITE 200
GRANTS PASS OR
97527-1706
US

IV. Provider business mailing address

1075 SW GRANDVIEW AVENUE SUITE 200
GRANTS PASS OR
97527-1706
US

V. Phone/Fax

Practice location:
  • Phone: 541-479-8363
  • Fax:
Mailing address:
  • Phone: 541-479-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10059315
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD203772
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: