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General NPI Number Information
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NPI Number | 1598925638
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Entity Type | Organization
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Legal Business Name | PREMIER UROLOGY CORP
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 430 ALTAIR PKWY STE 200
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City | WESTERVILLE
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State | OH
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Zip | 43082-7647
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Country | US
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Telephone | 614-818-0215
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Fax | 614-818-0217
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Provider Business Mailing Address
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Address Line | 430 ALTAIR PKWY STE 200
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City | WESTERVILLE
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State | OH
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Zip | 43082-7647
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Country | US
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Telephone | 614-818-0215
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Fax | 614-818-0217
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID H BROWN
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Credential | MD
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Telephone | 614-818-0215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35-075512
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License Number State | OH
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