MEDICARE: CONOR BROWN PA-C

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	2255A2300X	Athletic Trainer		CA
2	363A00000X	Physician Assistant	PA59057	CA
3	363AS0400X	Surgical Physician Assistant	PA59057	CA

General Provider Information

NPI Number	:	1922535152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONOR BROWN PA-C

Provider Business Mailing Address
First Line	:	2135 47TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1546
Country	:	US
Telephone Number	:	707-364-1763
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 BON AIR RD STE 120
Second Line	:
City	:	LARKSPUR
State	:	CA
Zip	:	94939-1142
Country	:	US
Telephone Number	:	415-927-5300
Fax Number	:	415-927-5300

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

Provider Enumeration Date	:	05/18/2017
Last Update Date	:	10/03/2023

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Directions to “ CONOR BROWN PA-C” Practice Location

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