MEDICARE: JEFFREY PAUL BROWN

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	174400000X	Specialist	PT25520	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WPT25520	OTHER	CA	PT LICENSE #

General Provider Information

NPI Number	:	1881644797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY PAUL BROWN

Provider Business Mailing Address
First Line	:	981 LOMAS SANTA FE DR
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-2144
Country	:	US
Telephone Number	:	858-794-9995
Fax Number	:	858-794-9962

Provider Business Practice Location Address
First Line	:	981 LOMAS SANTA FE DR
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-2144
Country	:	US
Telephone Number	:	858-794-9995
Fax Number	:	858-794-9962

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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