Provider Demographics
NPI:1851387005
Name:BROWN, ROGER F (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:F
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 1:1221 E SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3374
Mailing Address - Country:US
Mailing Address - Phone:559-450-5777
Mailing Address - Fax:559-449-2654
Practice Address - Street 1:1221 E SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3374
Practice Address - Country:US
Practice Address - Phone:559-450-5777
Practice Address - Fax:559-449-2654
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47402Medicare UPIN
ZZZ01252Medicare ID - Type Unspecified