Provider Demographics
NPI:1518012145
Name:BROWN, ALLEN JR (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 LYNCH ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-6534
Mailing Address - Country:US
Mailing Address - Phone:843-662-7455
Mailing Address - Fax:
Practice Address - Street 1:683 E PALMER RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-6648
Practice Address - Country:US
Practice Address - Phone:910-875-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101663363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical