Provider Demographics
NPI:1346709821
Name:BROWN, ERIC LEE (NP-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LEE
Last Name:BROWN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 S YELLOWSTONE HWY STE 304
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-5294
Mailing Address - Country:US
Mailing Address - Phone:208-359-2101
Mailing Address - Fax:208-356-8860
Practice Address - Street 1:859 S YELLOWSTONE HWY STE 304
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5294
Practice Address - Country:US
Practice Address - Phone:208-359-2101
Practice Address - Fax:208-356-8860
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDF12180562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine