Healthcare Provider Details

I. General information

NPI: 1154662948
Provider Name (Legal Business Name): CORY ALLEN BROWN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 HIGHLAND AVE STE 7
CLARKSTON WA
99403-2836
US

IV. Provider business mailing address

1630 23RD AVE SUITE 1001
LEWISTON ID
83501-6350
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-1119
  • Fax: 509-758-1140
Mailing address:
  • Phone: 208-553-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP-222
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: