Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101047266 | VA |
N | 208600000X | Surgeon | 0101047266 | VA |
Y | 2086S0129X | Vascular Surgeon | 0101047266 | VA |
NPI | 1073509634 |
---|---|
Provider Name | Dr. Jeff A Brown |
First Address | Henrico, VA 23294-4215 |
Second Address | Mechanicsville, VA 23116-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 04/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007305796 | (05) | VA |
C00105 | PTAN (01) | VA |