Provider Demographics
NPI:1811078132
Name:BRAWNER, JOHN CLIFTON (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLIFTON
Last Name:BRAWNER
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 1:1297 GARDNER WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9300
Mailing Address - Country:US
Mailing Address - Phone:541-779-4348
Mailing Address - Fax:541-779-4348
Practice Address - Street 1:1297 GARDNER WAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9300
Practice Address - Country:US
Practice Address - Phone:541-779-4348
Practice Address - Fax:541-779-4348
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13941208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR221911Medicaid
OR4898004OtherBLUE CROSS
OR4898004OtherBLUE CROSS
OR02WCGFLDMedicare ID - Type Unspecified