Healthcare Provider Details

I. General information

NPI: 1780063099
Provider Name (Legal Business Name): JEVON JAMES YARDLEY BROWN M.D (MEDICAL DOCTORA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 29TH STREET N.W FMC-RM 382
CALGARY ALBERTA
T2N 2T9
CA

IV. Provider business mailing address

4728 40TH AVE NE - 1A
SEATTLE WA
98105
US

V. Phone/Fax

Practice location:
  • Phone: 403-944-1110
  • Fax: 403-944-2840
Mailing address:
  • Phone: 206-327-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number60557019
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: