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General NPI Number Information
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NPI Number | 1629004650
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Entity Type | Individual
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Provider Name | STACEY LEE BROWN MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 150 PIONEER LN
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City | BISHOP
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State | CA
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Zip | 93514-2556
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Country | US
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Telephone | 760-920-0520
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Fax | 760-873-2897
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Provider Business Mailing Address
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Address Line | 940 STARLITE DR
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City | BISHOP
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State | CA
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Zip | 93514-7027
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Country | US
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Telephone | 760-873-2849
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Fax | 866-610-0738
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A54711
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License Number State | CA
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