Provider Demographics
NPI:1154334050
Name:BROWN, PERCY JR (N/A)
Entity Type:Individual
Prefix:MR
First Name:PERCY
Middle Name:
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 POYDRAS ST STE 1407
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-6101
Mailing Address - Country:US
Mailing Address - Phone:504-299-3407
Mailing Address - Fax:
Practice Address - Street 1:650 POYDRAS ST STE 1407
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-6101
Practice Address - Country:US
Practice Address - Phone:504-299-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3909150001Medicare ID - Type Unspecified