Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 4060 | AZ |
NPI | 1184651580 |
---|---|
Provider Name | Dr. Jonathan M Brown |
First Address | Fort Mohave, AZ 86426-8315 |
Second Address | Bullhead City, AZ 86442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 29/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
878209 | (05) | AZ |
I13958 | (02) | AZ |