Healthcare Provider Details

I. General information

NPI: 1811078132
Provider Name (Legal Business Name): JOHN CLIFTON BRAWNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 GARDNER WAY
MEDFORD OR
97504-9300
US

IV. Provider business mailing address

1297 GARDNER WAY
MEDFORD OR
97504-9300
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-4348
  • Fax: 541-779-4348
Mailing address:
  • Phone: 541-779-4348
  • Fax: 541-779-4348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD13941
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD13941
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: