Provider Demographics
NPI:1407030695
Name:BROWN, DAVID P (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1750 N WYMOUNT TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84602-4800
Mailing Address - Country:US
Mailing Address - Phone:801-422-2771
Mailing Address - Fax:801-422-0761
Practice Address - Street 1:1750 N WYMOUNT TERRACE DR
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602-4800
Practice Address - Country:US
Practice Address - Phone:801-422-2771
Practice Address - Fax:801-422-0761
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT359588-1204208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice