Provider Demographics
NPI:1619954633
Name:BROWN, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2434
Mailing Address - Country:US
Mailing Address - Phone:626-594-0478
Mailing Address - Fax:626-594-0575
Practice Address - Street 1:148 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2434
Practice Address - Country:US
Practice Address - Phone:626-594-0478
Practice Address - Fax:626-594-0575
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201222207PE0004X
CAA72839207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132J9Medicaid
NCH71861Medicare UPIN
NC2008095Medicare ID - Type Unspecified