Healthcare Provider Details

I. General information

NPI: 1699766139
Provider Name (Legal Business Name): JUDITH L BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 OAKWAY TER
EUGENE OR
97401-5109
US

IV. Provider business mailing address

2311 OAKWAY TER
EUGENE OR
97401-5109
US

V. Phone/Fax

Practice location:
  • Phone: 541-868-4971
  • Fax:
Mailing address:
  • Phone: 541-868-4971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD15948
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier08825-2
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: