Provider Demographics
NPI:1760479745
Name:W L BROWN MEDICAL CORPORATION
Entity Type:Organization
Organization Name:W L BROWN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:559-265-4444
Mailing Address - Street 1:1221 E SPRUCE AVE
Mailing Address - Street 2:C
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3374
Mailing Address - Country:US
Mailing Address - Phone:559-265-4444
Mailing Address - Fax:559-265-4454
Practice Address - Street 1:1221 E SPRUCE AVE
Practice Address - Street 2:C
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3374
Practice Address - Country:US
Practice Address - Phone:559-265-4444
Practice Address - Fax:559-265-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043300874OtherDR. BROWN JR NPI NUMBER
CA1002OtherCERT NURSE MIDWIFE
CA1225063969OtherANNE WILKES NPI NUMBER
CAA40710OtherCALIFORNIA MEDICAL LICENS
CAGROO29520Medicaid
CALAB73144FMedicaid
CA1225063969OtherANNE WILKES NPI NUMBER