Healthcare Provider Details

I. General information

NPI: 1225110489
Provider Name (Legal Business Name): SAMUEL Y BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3813 WILLIAMS BLVD
KENNER LA
70065-3007
US

IV. Provider business mailing address

3813 WILLIAMS BLVD
KENNER LA
70065-3007
US

V. Phone/Fax

Practice location:
  • Phone: 504-443-5437
  • Fax:
Mailing address:
  • Phone: 504-443-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number03309R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: