MEDICARE: DR. GREG A BROWN M.D.

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	207R00000X	Internal Medicine Physician	A40335	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A40335	OTHER	CA	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720135346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREG A BROWN M.D.

Provider Business Mailing Address
First Line	:	655 CAMINO DE LOS MARES
Second Line	:	SUITE 124
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-2809
Country	:	US
Telephone Number	:	949-661-9657
Fax Number	:	949-661-1352

Provider Business Practice Location Address
First Line	:	655 CAMINO DE LOS MARES
Second Line	:	SUITE 124
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-2809
Country	:	US
Telephone Number	:	949-661-9657
Fax Number	:	949-661-1352

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	12/16/2008

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