Provider Demographics
NPI:1508484882
Name:BROWN, DAVID JASON
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JASON
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 KAAWA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4984
Mailing Address - Country:US
Mailing Address - Phone:909-936-2159
Mailing Address - Fax:
Practice Address - Street 1:6255 KAAWA ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4984
Practice Address - Country:US
Practice Address - Phone:909-936-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman