Healthcare Provider Details

I. General information

NPI: 1881966893
Provider Name (Legal Business Name): JASON E BROWN PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N COAST HWY STE 200
NEWPORT OR
97365-3117
US

IV. Provider business mailing address

407 N COAST HWY STE 200
NEWPORT OR
97365-3117
US

V. Phone/Fax

Practice location:
  • Phone: 541-703-3185
  • Fax: 541-939-8202
Mailing address:
  • Phone: 541-703-3185
  • Fax: 541-939-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA156782
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: