Provider Demographics
NPI:1881644797
Name:BROWN, JEFFREY PAUL
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 LOMAS SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2144
Mailing Address - Country:US
Mailing Address - Phone:858-794-9995
Mailing Address - Fax:858-794-9962
Practice Address - Street 1:981 LOMAS SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2144
Practice Address - Country:US
Practice Address - Phone:858-794-9995
Practice Address - Fax:858-794-9962
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25520174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT25520OtherPT LICENSE #
CAW14625AMedicare ID - Type Unspecified
CAWPT25520Medicare ID - Type Unspecified
CAWPT25520OtherPT LICENSE #
CAWPT25520BMedicare ID - Type Unspecified
WPT25520AMedicare ID - Type Unspecified