Provider Demographics
NPI:1033200688
Name:BROWN, ELISABETH DEWEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:DEWEY
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12400 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-4750
Mailing Address - Country:US
Mailing Address - Phone:562-789-5434
Mailing Address - Fax:562-863-1903
Practice Address - Street 1:12400 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4750
Practice Address - Country:US
Practice Address - Phone:562-789-5434
Practice Address - Fax:562-863-1903
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA73809BMedicare ID - Type Unspecified
CAH91906Medicare UPIN