Provider Demographics
NPI:1124210018
Name:BROWN, SPENCER LELAND (MD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:LELAND
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6076 BRISTOL PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6600
Mailing Address - Country:US
Mailing Address - Phone:310-348-9604
Mailing Address - Fax:310-338-1219
Practice Address - Street 1:2080 CENTURY PARK E STE 1807
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2021
Practice Address - Country:US
Practice Address - Phone:310-552-1077
Practice Address - Fax:310-552-0861
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG466532086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G466530Medicaid
CAA92665Medicare UPIN
CA00G466530Medicaid