Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 2007004395 | MO |
Y | 207T00000X | Neurosurgeon | 273253 | MA |
N | 207T00000X | Neurosurgeon | A117012 | CA |
NPI | 1033234562 |
---|---|
Provider Name | Dr. Justin M Brown |
First Address | San Diego, CA 92193-2410 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 07/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033234562 | (05) | CA |
206315707 | (05) | MO |