Healthcare Provider Details

I. General information

NPI: 1568402691
Provider Name (Legal Business Name): BRUCE R BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 UNION ST SUITE 12
BANGOR ME
04401-3053
US

IV. Provider business mailing address

43 WHITING HILL RD SUITE 300
BREWER ME
04412-1005
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-7979
  • Fax: 207-947-9579
Mailing address:
  • Phone: 207-973-5035
  • Fax: 207-973-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number011063
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: