Healthcare Provider Details

I. General information

NPI: 1013020411
Provider Name (Legal Business Name): DOUGLAS ALBERT BROWNELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE STE 850
ORANGE CA
92868-4218
US

IV. Provider business mailing address

16751 BLANTON ST APT D
HUNTINGTON BEACH CA
92649-3857
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-4961
  • Fax: 714-560-4455
Mailing address:
  • Phone: 714-377-8768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG019871
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD428117
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: