Healthcare Provider Details

I. General information

NPI: 1053374173
Provider Name (Legal Business Name): DAVID J BROWN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ROUTE 73 S SUITE 304
MARLTON NJ
08053-9642
US

IV. Provider business mailing address

525 ROUTE 73 S SUITE 304
MARLTON NJ
08053-9642
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-5144
  • Fax:
Mailing address:
  • Phone: 856-983-5144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD00121900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: