Healthcare Provider Details

I. General information

NPI: 1851387005
Provider Name (Legal Business Name): ROGER F BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E SPRUCE AVE
FRESNO CA
93720-3374
US

IV. Provider business mailing address

1221 E SPRUCE AVE
FRESNO CA
93720-3374
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-5777
  • Fax: 559-449-2654
Mailing address:
  • Phone: 559-450-5777
  • Fax: 559-449-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG38222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: