Provider Demographics
NPI:1790781995
Name:BROWN, ALFRED JERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:JERRY
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 1:1995 ERRECART BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8337
Mailing Address - Country:US
Mailing Address - Phone:775-738-2600
Mailing Address - Fax:
Practice Address - Street 1:1995 ERRECART BLVD STE 207
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8337
Practice Address - Country:US
Practice Address - Phone:775-738-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56361208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G563610OtherMEDI CAL #
CA00G563610OtherMEDI CAL #