Provider Demographics
NPI:1598858896
Name:SCOTT LOGAN BROWN, MD, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:SCOTT LOGAN BROWN, MD, A PROFESSIONAL CORP
Other - Org Name:SCOTT LOGAN BROWN,MD, A PROFESSIONAL CORP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:LOGAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-828-1000
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85788208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071060Medicaid
CAH04985Medicare UPIN