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General NPI Number Information
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NPI Number | 1689692774
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Entity Type | Individual
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Provider Name | BLAINE BROWN MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 2101 N WATERMAN AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-4836
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Country | US
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Telephone | 909-883-8711
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Fax |
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Provider Business Mailing Address
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Address Line | 3824 RIVERWOOD DR
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City | PROVO
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State | UT
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Zip | 84604-6094
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Country | US
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Telephone | 800-883-7243
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Fax | 714-647-1245
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 179635-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A96642
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License Number State | CA
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