Provider Demographics
NPI:1437775558
Name:VARNER, JOHN ALAN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:VARNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 N LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4115
Mailing Address - Country:US
Mailing Address - Phone:503-283-2852
Mailing Address - Fax:
Practice Address - Street 1:5833 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4115
Practice Address - Country:US
Practice Address - Phone:503-283-2852
Practice Address - Fax:503-283-4868
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR520711171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator