Healthcare Provider Details

I. General information

NPI: 1497928998
Provider Name (Legal Business Name): GERALD E. BROWN, D.O., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 LINDELL RD
LAS VEGAS NV
89146-5409
US

IV. Provider business mailing address

2575 LINDELL RD
LAS VEGAS NV
89146-5409
US

V. Phone/Fax

Practice location:
  • Phone: 702-362-3937
  • Fax: 702-362-5109
Mailing address:
  • Phone: 702-362-3937
  • Fax: 702-362-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number855
License Number StateNV

VIII. Authorized Official

Name: DR. GERALD E. BROWN
Title or Position: OWNER
Credential: D.O.
Phone: 702-362-3937