Healthcare Provider Details

I. General information

NPI: 1417990607
Provider Name (Legal Business Name): IRVING BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 NANI STREET
WAILUKU HI
96793-1881
US

IV. Provider business mailing address

1881 NANI STREET
WAILUKU HI
96793-1811
US

V. Phone/Fax

Practice location:
  • Phone: 808-871-7772
  • Fax: 808-872-4028
Mailing address:
  • Phone: 808-871-7772
  • Fax: 808-872-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD5113
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: