Healthcare Provider Details

I. General information

NPI: 1033232459
Provider Name (Legal Business Name): BRUCE H BROWN JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVENUE SUITE 106
PHOENIX AZ
85022-4014
US

IV. Provider business mailing address

PO BOX 13385
SCOTTSDALE AZ
85267-3385
US

V. Phone/Fax

Practice location:
  • Phone: 480-609-9300
  • Fax: 480-609-9350
Mailing address:
  • Phone: 480-609-9300
  • Fax: 480-609-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34054
License Number StateAZ

VIII. Authorized Official

Name: BRUCE H BROWN JR.
Title or Position: OWNER
Credential: MD
Phone: 480-609-9300