Healthcare Provider Details

I. General information

NPI: 1356668644
Provider Name (Legal Business Name): HOSEA E BROWN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 KARICIO LN SUITE 2A
PRESCOTT AZ
86303-6836
US

IV. Provider business mailing address

PO BOX 1503
PALM SPRINGS CA
92263-1503
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-4645
  • Fax: 760-320-6244
Mailing address:
  • Phone: 760-320-9464
  • Fax: 760-320-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number24719
License Number StateAZ

VIII. Authorized Official

Name: DR. HOSEA E BROWN
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 760-320-9464