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General NPI Number Information
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NPI Number | 1275980989
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Entity Type | Individual
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Provider Name | JENS BROWN D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 3119 WOODMAN DR
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City | ALTOONA
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State | WI
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Zip | 54720-2668
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Country | US
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Telephone | 715-717-6700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19070
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City | GREEN BAY
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State | WI
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Zip | 54307-9070
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Country | US
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Telephone | 920-496-4700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 5101022503
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 75754-21
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License Number State | WI
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