Provider Demographics
NPI:1124482815
Name:BROUGHAM, JARED (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:BROUGHAM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8458
Mailing Address - Country:US
Mailing Address - Phone:541-779-1672
Mailing Address - Fax:
Practice Address - Street 1:2900 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8458
Practice Address - Country:US
Practice Address - Phone:541-779-1672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD222114207T00000X
CODR.0071013207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery