MEDICARE: MR. JON-GLEN ALLAN BROWN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1477989168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JON-GLEN ALLAN BROWN PA

Provider Business Mailing Address
First Line	:	2404 MOUNTAIN RAIL DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3128
Country	:	US
Telephone Number	:	210-560-7870
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 MOUNTAIN RAIL DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3128
Country	:	US
Telephone Number	:	210-560-7870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	09/25/2013

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