Healthcare Provider Details

I. General information

NPI: 1487007159
Provider Name (Legal Business Name): MR. HERBERT LEE BROWN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24823 PACIFIC HWY S
KENT WA
98032-5478
US

IV. Provider business mailing address

1112UMMIT AVE
SEATTLE WA
98081
US

V. Phone/Fax

Practice location:
  • Phone: 253-681-0010
  • Fax: 253-681-0014
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: