Provider Demographics
NPI:1306865837
Name:BROWN, JOHN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-507-2419
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1302 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0246
Practice Address - Country:US
Practice Address - Phone:702-657-9555
Practice Address - Fax:702-657-9040
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV11278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1306865837Medicaid
NVP00892340OtherRAILROAD MEDICARE
NV1306865837Medicaid