Healthcare Provider Details

I. General information

NPI: 1821587924
Provider Name (Legal Business Name): LAURA MARIE F BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE 8TH ST STE 300
GRESHAM OR
97030-7318
US

IV. Provider business mailing address

600 NE 8TH ST STE 300
GRESHAM OR
97030-7318
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-5558
  • Fax: 503-988-5185
Mailing address:
  • Phone: 503-988-5558
  • Fax: 503-988-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number206041
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: