Healthcare Provider Details

I. General information

NPI: 1679726095
Provider Name (Legal Business Name): OPTIMAL HEALTH PRIMARY CARE BROWN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 S EASTERN AVE STE 100
HENDERSON NV
89052-3952
US

IV. Provider business mailing address

10120 S EASTERN AVE STE 100
HENDERSON NV
89052-3952
US

V. Phone/Fax

Practice location:
  • Phone: 702-871-7004
  • Fax: 702-871-7005
Mailing address:
  • Phone: 702-871-7004
  • Fax: 702-871-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY L BROWN
Title or Position: PRESIDENT
Credential: DO
Phone: 702-871-7004