Healthcare Provider Details

I. General information

NPI: 1992024640
Provider Name (Legal Business Name): ISRAEL K BROWN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ISRAEL KWAME O.B. BRANTUOH

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2137 HERNDON AVE SUITE 102
CLOVIS CA
93611-6306
US

IV. Provider business mailing address

1070 N DEWITT AVE
CLOVIS CA
93611-7040
US

V. Phone/Fax

Practice location:
  • Phone: 559-466-7100
  • Fax: 559-466-7102
Mailing address:
  • Phone: 559-466-7100
  • Fax: 559-466-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2010003179
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A11716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: