Healthcare Provider Details

I. General information

NPI: 1417955055
Provider Name (Legal Business Name): JEFFREY ALLAN BROWN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 PICKENS ST
EUTAW AL
35462-1123
US

IV. Provider business mailing address

204 PICKENS ST
EUTAW AL
35462-1123
US

V. Phone/Fax

Practice location:
  • Phone: 205-372-0708
  • Fax: 205-372-0720
Mailing address:
  • Phone: 205-372-0708
  • Fax: 205-372-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number187
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: