Provider Demographics
NPI:1275006678
Name:BROWN JR., BRIMMER S
Entity Type:Individual
Prefix:MR
First Name:BRIMMER
Middle Name:S
Last Name:BROWN JR.
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 TULANE AVE APT 116
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6994
Mailing Address - Country:US
Mailing Address - Phone:318-709-2004
Mailing Address - Fax:
Practice Address - Street 1:7060 READ LN STE 200
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2367
Practice Address - Country:US
Practice Address - Phone:504-246-9860
Practice Address - Fax:504-246-9861
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator