Provider Demographics
NPI:1477592681
Name:BROWN, SCOTT LOGAN (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LOGAN
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 1:8881 FLETCHER PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3191
Mailing Address - Country:US
Mailing Address - Phone:619-828-1000
Mailing Address - Fax:619-828-1001
Practice Address - Street 1:8881 FLETCHER PKWY STE 250
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3191
Practice Address - Country:US
Practice Address - Phone:619-828-1000
Practice Address - Fax:619-828-1001
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85788208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071060Medicaid
CAH04985Medicare UPIN
CAGR0071060Medicaid