John Rodgers Braddock, M.D.

Primary specialty

Preventive Medicine/Occupational Environmental Medicine PhysicianTaxonomy code 2083P0500X

License

MD09593 Issued in OR

Practice address

4000 Kruse Way PL
Building 2, Suite 160
Lake Oswego, OR 97035-5545

Phone

(503) 635-1960

Fax

(503) 635-8354

NPI assigned

Feb 1, 2007

Last updated

Nov 15, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cascade Occupational Medicine Physicians Inc

  • Occupational Medicine Clinic/Center
  • Hillsboro, OR
  • NPI 1124159819
  Authorized official Same address or phone
• Cascade Occupational Medicine Physicians Inc

  • Occupational Medicine Clinic/Center
  • Tualatin, OR
  • NPI 1356327803
  Authorized official Same address or phone
• Cascasde Occupational Medicine Physicians Inc

  • Physical Therapy Clinic/Center
  • Lake Oswego, OR
  • NPI 1437280120
  Authorized official Same address or phone
• Sendant MD,Inc.

  • Clinic/Center
  • West Linn, OR
  • NPI 1194160515
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321315200000",
    "number": "1225176324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 KRUSE WAY PL",
            "address_2": "BUILDING 2, SUITE 160",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970355545",
            "telephone_number": "503-635-1960",
            "fax_number": "503-635-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 KRUSE WAY PL",
            "address_2": "BUILDING 2, SUITE 160",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970355545",
            "telephone_number": "503-635-1960",
            "fax_number": "503-635-8354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADDOCK",
        "first_name": "JOHN",
        "middle_name": "RODGERS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2011-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD09593",
            "primary": false
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "OR",
            "license": "MD09593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lilian Renata Bornio Carrillo
• Pamela K Bosa, NP
• Carlie Boswell
• Larry Bowden, DMD
• Jessica Rochelle Bradburn, M.A.
• Shannon Braden, ND
• Jacqueline Bradford, MA, MFT, NCC
• Bradley E Sievert DMD PC (Westlake Family Dentistry)
• Nicholas Bradshaw, MT
• Charles L Branen, DMD, PC

• Preventive Medicine/Occupational Environmental Medicine Physician in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Preventive Medicine/Occupational Environmental Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.