Healthcare Provider Details

I. General information

NPI: 1598724684
Provider Name (Legal Business Name): ROBERT C BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8857 1ST ST STE 400 DDG CLASSRON-EHSLANT
NORFOLK VA
23511-3713
US

IV. Provider business mailing address

DDG CLASSRON 8857 FIRST STREET, SUITE 400
FPO AE
23511
US

V. Phone/Fax

Practice location:
  • Phone: 757-445-7255
  • Fax: 757-445-3088
Mailing address:
  • Phone: 757-445-7255
  • Fax: 757-445-3088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: