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General NPI Number Information
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NPI Number | 1518261544
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Entity Type | Organization
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Legal Business Name | J. COREY BROWN, PLLC
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 4880 WYNN RD
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City | LAS VEGAS
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State | NV
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Zip | 89103-5406
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Country | US
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Telephone | 702-430-3820
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Fax | 702-222-0645
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Provider Business Mailing Address
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Address Line | 4880 WYNN RD
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City | LAS VEGAS
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State | NV
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Zip | 89103-5406
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Country | US
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Telephone | 702-430-3820
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Fax | 702-222-0645
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JANICE K ECKES
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Credential | R.N.
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Telephone | 702-430-3820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2950
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License Number State | NV
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