Provider Demographics
NPI:1639479041
Name:BROWNE, DEREK MCGRATH (DO)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:MCGRATH
Last Name:BROWNE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:22719 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3613
Mailing Address - Country:US
Mailing Address - Phone:657-241-8640
Mailing Address - Fax:714-665-4669
Practice Address - Street 1:22719 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3613
Practice Address - Country:US
Practice Address - Phone:657-241-8640
Practice Address - Fax:714-665-4669
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2019-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A10903207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01460367-EFF 2/9/15OtherRR MEDICARE-DU4032
CAEFF.8/22/2011Medicaid
CAGA222B-EFF 2/9/15Medicare UPIN
CAGB232B- EFF 2/9/15Medicare UPIN