Healthcare Provider Details

I. General information

NPI: 1083907059
Provider Name (Legal Business Name): COBY THOMAS BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 S 1470 E STE 200
SAINT GEORGE UT
84790-1762
US

IV. Provider business mailing address

295 S 1470 E STE 200
SAINT GEORGE UT
84790-1762
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-1662
  • Fax: 435-628-1722
Mailing address:
  • Phone: 435-628-1662
  • Fax: 435-628-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9362887-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: