Provider Demographics
NPI:1073511879
Name:BROWN, J. DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:DAVID
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:JON
Other - Middle Name:DAVID
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:3011 S LINDSAY RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-4332
Mailing Address - Country:US
Mailing Address - Phone:480-759-6737
Mailing Address - Fax:480-759-5404
Practice Address - Street 1:3011 S LINDSAY RD
Practice Address - Street 2:SUITE 113
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4332
Practice Address - Country:US
Practice Address - Phone:480-759-6737
Practice Address - Fax:480-759-5404
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0383213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU35276Medicare UPIN
AZ76494Medicare ID - Type UnspecifiedMEDICARE PROV NO