Provider Demographics
NPI:1679814222
Name:BROWN, JEFFERY BRENT DANIELS (DO)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:BRENT DANIELS
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 MEDICAL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3286
Mailing Address - Country:US
Mailing Address - Phone:435-695-2273
Mailing Address - Fax:
Practice Address - Street 1:970 MEDICAL DR STE 202
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3286
Practice Address - Country:US
Practice Address - Phone:435-695-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10893163-1204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology