Provider Demographics
NPI:1639356892
Name:BRUCE A BROWN MD,INC
Entity Type:Organization
Organization Name:BRUCE A BROWN MD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PATIENT ACCOUNT MGMT.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWORDS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC,CCP
Authorized Official - Phone:858-558-8488
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:STE 1190W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-453-3460
Mailing Address - Fax:310-453-3636
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:STE 1190W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-453-3460
Practice Address - Fax:310-453-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41253207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty