Provider Demographics
NPI:1679726095
Name:OPTIMAL HEALTH PRIMARY CARE BROWN PC
Entity Type:Organization
Organization Name:OPTIMAL HEALTH PRIMARY CARE BROWN PC
Other - Org Name:OPTIMAL HEALTH PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-871-7004
Mailing Address - Street 1:10120 S EASTERN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3952
Mailing Address - Country:US
Mailing Address - Phone:702-871-7004
Mailing Address - Fax:702-871-7005
Practice Address - Street 1:10120 S EASTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3952
Practice Address - Country:US
Practice Address - Phone:702-871-7004
Practice Address - Fax:702-871-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBD705AMedicare PIN