Healthcare Provider Details

I. General information

NPI: 1043300874
Provider Name (Legal Business Name): WILLIE LEE BROWN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 N FRESNO ST STE 104
FRESNO CA
93710-5268
US

IV. Provider business mailing address

6225 N FRESNO ST STE 104
FRESNO CA
93710-5268
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-4444
  • Fax: 559-265-4454
Mailing address:
  • Phone: 559-265-4444
  • Fax: 559-265-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA40710
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA40710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: