Healthcare Provider Details

I. General information

NPI: 1932542198
Provider Name (Legal Business Name): FALON VICTORIA BROWN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N 5TH ST
PONCHATOULA LA
70454-2532
US

IV. Provider business mailing address

180 N 5TH ST
PONCHATOULA LA
70454-2532
US

V. Phone/Fax

Practice location:
  • Phone: 985-370-7546
  • Fax: 985-370-7765
Mailing address:
  • Phone: 985-370-7546
  • Fax: 985-370-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberDO000443
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017-01220
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO.000443
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: