Provider Demographics
NPI:1598724684
Name:BROWN, ROBERT C
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
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:DDG CLASSRON
Mailing Address - Street 2:8857 FIRST STREET, SUITE 400
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:23511
Mailing Address - Country:US
Mailing Address - Phone:757-445-7255
Mailing Address - Fax:757-445-3088
Practice Address - Street 1:8857 1ST ST STE 400
Practice Address - Street 2:DDG CLASSRON-EHSLANT
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-3713
Practice Address - Country:US
Practice Address - Phone:757-445-7255
Practice Address - Fax:757-445-3088
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman