Provider Demographics
NPI:1013020411
Name:BROWNELL, DOUGLAS ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALBERT
Last Name:BROWNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16751 BLANTON ST APT D
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3857
Mailing Address - Country:US
Mailing Address - Phone:714-377-8768
Mailing Address - Fax:
Practice Address - Street 1:1140 W LA VETA AVE STE 850
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4218
Practice Address - Country:US
Practice Address - Phone:714-997-4961
Practice Address - Fax:714-560-4455
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0198712086S0129X
PAMD4281172086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40778Medicare UPIN