Provider Demographics
NPI:1891143095
Name:BRAUNLICH, PHILLIP ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:ROBERT
Last Name:BRAUNLICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 NW STEWART PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1516
Mailing Address - Country:US
Mailing Address - Phone:716-248-1753
Mailing Address - Fax:
Practice Address - Street 1:2460 NW STEWART PKWY STE 104
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1516
Practice Address - Country:US
Practice Address - Phone:541-229-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELT22005207X00000X
FLOS18517207X00000X
FLUO4916208D00000X
OROS18517207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice