Provider Demographics
NPI:1417990607
Name:BROWN, IRVING (MD)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 NANI STREET
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1811
Mailing Address - Country:US
Mailing Address - Phone:808-871-7772
Mailing Address - Fax:808-872-4028
Practice Address - Street 1:1881 NANI STREET
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1881
Practice Address - Country:US
Practice Address - Phone:808-871-7772
Practice Address - Fax:808-872-4028
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD5113173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI071290-01Medicaid
HI53043Medicare ID - Type Unspecified
HIF23021Medicare UPIN