Provider Demographics
NPI:1518261544
Name:J. COREY BROWN, PLLC
Entity Type:Organization
Organization Name:J. COREY BROWN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ECKES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-430-3820
Mailing Address - Street 1:4880 WYNN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5406
Mailing Address - Country:US
Mailing Address - Phone:702-430-3820
Mailing Address - Fax:702-222-0645
Practice Address - Street 1:4880 WYNN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5406
Practice Address - Country:US
Practice Address - Phone:702-430-3820
Practice Address - Fax:702-222-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2950208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty