Provider Demographics
NPI:1326496522
Name:BRAUNLICH, KATHERINE WEBER (DO)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:WEBER
Last Name:BRAUNLICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 NW EDENBOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8847
Mailing Address - Country:US
Mailing Address - Phone:541-957-1141
Mailing Address - Fax:
Practice Address - Street 1:2440 NW EDENBOWER BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8847
Practice Address - Country:US
Practice Address - Phone:541-957-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319446207N00000X
FLOS16881207N00000X
FLUO4938208D00000X
FL390200000X
ORDO216207207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program