Provider Demographics
NPI:1083845507
Name:BROWN, ROY ANTHONY (ROY BROWN)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:ANTHONY
Last Name:BROWN
Suffix:
Gender:M
Credentials:ROY BROWN
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ROY BROWN
Mailing Address - Street 1:5288 EASTGATE MALL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2835
Mailing Address - Country:US
Mailing Address - Phone:619-218-6460
Mailing Address - Fax:
Practice Address - Street 1:5288 EASTGATE MALL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2835
Practice Address - Country:US
Practice Address - Phone:619-218-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF000699292471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography