Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | MD 032402-E | PA |
NPI | 1417081803 |
---|---|
Provider Name | Dr. Louis Alfred Brown JR. |
First Address | Philadelphia, PA 19111-5630 |
Second Address | Philadelphia, PA 19111-5630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 12/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001070126 | (05) | PA |
C32306 | (02) | PA |