Healthcare Provider Details

I. General information

NPI: 1326496522
Provider Name (Legal Business Name): KATHERINE WEBER BRAUNLICH D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 NW EDENBOWER BLVD
ROSEBURG OR
97471-8847
US

IV. Provider business mailing address

2440 NW EDENBOWER BLVD
ROSEBURG OR
97471-8847
US

V. Phone/Fax

Practice location:
  • Phone: 541-957-1141
  • Fax:
Mailing address:
  • Phone: 541-957-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number319446
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS16881
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberDO216207
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberUO4938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: