Individual
DR. JOHN WILLIAM BRAZER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
790 E 5TH ST, COQUILLE, OR 97423-1755
(541) 396-3111
(541) 396-5222
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD07716
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011239
—
OR
01
—
080059412
RR MEDICARE PTAN NUMBER
OR
01
—
1407812365
NBMC NPI NUMBER-GROUP
OR
01
—
930635514
GROUP TAX ID
OR
01
—
CD8723
RR MEDICARE GROUP NUMBER
OR
01
—
MD07716
MEDICAL LICENSE OREGON
OR
01
—
R0000WFBTV
GROUP MEDICARE PIN
OR
Enumeration date
12/08/2005
Last updated
03/23/2010
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