Provider Demographics
NPI:1780653030
Name:BROWN, GLENN H (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:H
Last Name:BROWN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1450 S DOBSON RD
Mailing Address - Street 2:#320B
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4712
Mailing Address - Country:US
Mailing Address - Phone:480-835-9755
Mailing Address - Fax:480-964-8668
Practice Address - Street 1:1450 S DOBSON RD
Practice Address - Street 2:#320B
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4712
Practice Address - Country:US
Practice Address - Phone:480-835-9755
Practice Address - Fax:480-964-8668
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-12-19
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Provider Licenses
StateLicense IDTaxonomies
AZ14201207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology