Provider Demographics
NPI:1659305001
Name:BROWN, JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
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 1:10350 WILSHIRE BLVD
Mailing Address - Street 2:#1003
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:310-447-4645
Mailing Address - Fax:310-858-0025
Practice Address - Street 1:10350 WILSHIRE BLVD
Practice Address - Street 2:#1003
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:310-447-4645
Practice Address - Fax:310-858-0025
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26942207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C269420OtherMEDICAL PPIN #
CA00C269420OtherMEDICAL PPIN #
CAWC26942FMedicare ID - Type UnspecifiedPPIN #