Provider Demographics
NPI:1013911361
Name:QUAVE, BRETT T (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:T
Last Name:QUAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8153
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0453
Mailing Address - Country:US
Mailing Address - Phone:541-494-1111
Mailing Address - Fax:541-494-1099
Practice Address - Street 1:701 GOLF VIEW DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9643
Practice Address - Country:US
Practice Address - Phone:541-494-1111
Practice Address - Fax:541-494-1099
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75659207LP2900X
WAMD00048162208VP0000X
ORMD157375207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8488843Medicaid
OR500647357OtherMEDICAID (DMAP)
CAI06503Medicare UPIN
OR500647357OtherMEDICAID (DMAP)
WA8488843Medicaid
CA00A756590Medicare PIN