Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | G46653 | CA |
NPI | 1124210018 |
---|---|
Provider Name | Dr. Spencer Leland Brown |
First Address | Culver City, CA 90230-6600 |
Second Address | Los Angeles, CA 90067-2021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 30/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G466530 | (05) | CA |
A92665 | (02) | CA |