Provider Demographics
NPI:1134306236
Name:BROWN, CHARLES FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FRANKLIN
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:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1045 ATLANTIC AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3408
Practice Address - Country:US
Practice Address - Phone:562-437-6982
Practice Address - Fax:562-624-0741
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1024162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHW881OtherPTAN ST MARYS
CA00A102416Medicaid
CAHW8412BOtherGROUP PTAN COMMUNITY HOSP
CAHWA8412AOtherGROUP PTAN PACIFIC HOSP