=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619947546
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN BROWN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2006
-----------------------------------------------------
Last Update Date | 07/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | NORTHEAST IOWA PATHOLOGY ASSOCIATES, PC 1825 LOGAN AVENUE
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-235-3679
-----------------------------------------------------
Fax | 319-233-0722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | NORTHEAST IOWA PATHOLOGY ASSOCIATES, PC PO BOX 2818
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50704-2818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-233-3044
-----------------------------------------------------
Fax | 319-233-0722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0101X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology Physician
-----------------------------------------------------
License Number | 27676
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------