MEDICARE: EDWARD WILLIAM BROWN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G38495	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124003793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD WILLIAM BROWN M.D.

Provider Business Mailing Address
First Line	:	3860 CALLE FORTUNADA
Second Line	:	STE #210
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4802
Country	:	US
Telephone Number	:	858-309-6300
Fax Number	:	858-309-6291

Provider Business Practice Location Address
First Line	:	3750 CONVOY ST
Second Line	:	SUITE 301
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3738
Country	:	US
Telephone Number	:	858-292-4313
Fax Number	:	858-292-1612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	10/19/2012

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