Healthcare Provider Details

I. General information

NPI: 1083845507
Provider Name (Legal Business Name): ROY ANTHONY BROWN ROY BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY BROWN ROY BROWN

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CLIFF MANOR LN
GALLATIN GATEWAY MT
59730-9746
US

IV. Provider business mailing address

5288 EASTGATE MALL
SAN DIEGO CA
92121-2835
US

V. Phone/Fax

Practice location:
  • Phone: 619-218-6460
  • Fax:
Mailing address:
  • Phone: 619-218-6460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberRHF00069929
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License NumberRTS-RT-LIC-19005
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: