Provider Demographics
NPI:1629430814
Name:BROWN, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8881 FLETCHER PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3187
Mailing Address - Country:US
Mailing Address - Phone:619-464-6434
Mailing Address - Fax:619-464-5109
Practice Address - Street 1:8881 FLETCHER PKWY STE 205
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3187
Practice Address - Country:US
Practice Address - Phone:619-270-4388
Practice Address - Fax:619-937-3767
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA154289207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine