Provider Demographics
NPI:1013953058
Name:BROWN, LAWRENCE A (DPM)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SUPERIOR AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3600
Mailing Address - Country:US
Mailing Address - Phone:949-642-2329
Mailing Address - Fax:949-646-3318
Practice Address - Street 1:1501 SUPERIOR AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3600
Practice Address - Country:US
Practice Address - Phone:949-642-2329
Practice Address - Fax:949-646-3318
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3142213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3142Medicare ID - Type Unspecified
T19277Medicare UPIN