Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 041435 | CT |
Y | 207QS0010X | Family Doctor - Sports Medicine | 041435 | CT |
NPI | 1306840640 |
---|---|
Provider Name | Dr. Jeffrey R Brown |
First Address | West Hartford, CT 06110 |
Second Address | West Hartford, CT 06110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001414359 | (05) | CT |
I13192 | (02) |