Healthcare Provider Details

I. General information

NPI: 1366412157
Provider Name (Legal Business Name): WILLIAM MALCOLM BROWN III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/20/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CEDAR ST
JULESBURG CO
80737-1121
US

IV. Provider business mailing address

900 CEDAR ST
JULESBURG CO
80737-1121
US

V. Phone/Fax

Practice location:
  • Phone: 970-474-3323
  • Fax:
Mailing address:
  • Phone: 970-474-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: