Provider Demographics
NPI:1043300874
Name:BROWN, WILLIE LEE JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:LEE
Last Name:BROWN
Suffix:JR
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 1:6225 N FRESNO ST
Mailing Address - Street 2:STE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5268
Mailing Address - Country:US
Mailing Address - Phone:559-265-4444
Mailing Address - Fax:559-265-4454
Practice Address - Street 1:6225 N FRESNO ST
Practice Address - Street 2:STE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5268
Practice Address - Country:US
Practice Address - Phone:559-265-4444
Practice Address - Fax:559-265-4454
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40710207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A407100OtherMEDICAID INDIVIDUAL
CAGR0029520Medicaid
CAGR0029520Medicaid
CAZZZ18968ZMedicare Oscar/Certification
CA00A407100Medicare PIN