Provider Demographics
NPI:1912433772
Name:JAVERNICK, LAUREN (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:JAVERNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BOMBARDIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1075 SW GRANDVIEW AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-1706
Mailing Address - Country:US
Mailing Address - Phone:541-479-8363
Mailing Address - Fax:
Practice Address - Street 1:1075 SW GRANDVIEW AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-1706
Practice Address - Country:US
Practice Address - Phone:541-479-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10059315390200000X
ORMD203772207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program