Provider Demographics
NPI:1114914728
Name:BROWN, GREG W (MD)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:W
Last Name:BROWN
Suffix:
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 1:445 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4084
Mailing Address - Country:US
Mailing Address - Phone:503-640-2757
Mailing Address - Fax:503-640-9753
Practice Address - Street 1:445 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4084
Practice Address - Country:US
Practice Address - Phone:503-640-2757
Practice Address - Fax:503-640-9753
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19888208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
R163533OtherPTAN
OR081856Medicaid
OR023873001OtherBLUE CROSS/BLUE SHIELD
OR3460807OtherCIGNA
OR081856Medicaid
OR3460807OtherCIGNA