Healthcare Provider Details

I. General information

NPI: 1659884401
Provider Name (Legal Business Name): SAVANA MARISA BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAVANA MARISA COCHRANE PA-C

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL CENTER DR STE 300
MEDFORD OR
97504-4316
US

IV. Provider business mailing address

520 MEDICAL CENTER DR STE 300
MEDFORD OR
97504-4316
US

V. Phone/Fax

Practice location:
  • Phone: 541-930-8907
  • Fax: 541-245-4820
Mailing address:
  • Phone: 541-930-8907
  • Fax: 541-245-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA190601
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: