Healthcare Provider Details

I. General information

NPI: 1508081894
Provider Name (Legal Business Name): GREGORY PENINGER BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 W WARM SPRINGS RD STE 110
HENDERSON NV
89014
US

IV. Provider business mailing address

5120 TENNIS COURT ST W
LAS VEGAS NV
89120-1348
US

V. Phone/Fax

Practice location:
  • Phone: 702-232-3256
  • Fax:
Mailing address:
  • Phone: 702-232-3256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7733
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number7733
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: