Healthcare Provider Details

I. General information

NPI: 1598993248
Provider Name (Legal Business Name): IAN ELLIOTT BROWN M.D./PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD. - DEPARTMENT OF SURGERY NAOB SUITE 5006
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2315 STOCKTON BLVD., DEPARTMENT OF SURGERY NAOB, SUITE 5104
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1239
  • Fax:
Mailing address:
  • Phone: 916-734-1279
  • Fax: 916-734-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA108671
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA108671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: