Healthcare Provider Details

I. General information

NPI: 1912907783
Provider Name (Legal Business Name): JEFFREY BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16315 NE 87TH ST STE B6
REDMOND WA
98052-3537
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98055-2908
US

V. Phone/Fax

Practice location:
  • Phone: 425-882-1697
  • Fax: 425-885-4179
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00024051
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: