Provider Demographics
NPI:1083776322
Name:BROWN, WARREN SHELBURNE III (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:SHELBURNE
Last Name:BROWN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:529 W SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2364
Mailing Address - Country:US
Mailing Address - Phone:626-355-8595
Mailing Address - Fax:626-355-8591
Practice Address - Street 1:529 W SIERRA MADRE BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2364
Practice Address - Country:US
Practice Address - Phone:626-355-8595
Practice Address - Fax:626-355-8591
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA70884207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA70884OtherSTATE MEDICAL LICENSE NUM
BB7066978OtherDEA NUMBER
CAH67902Medicare UPIN