Provider Demographics
NPI:1124003793
Name:BROWN, EDWARD WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:WILLIAM
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:STE #210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4802
Mailing Address - Country:US
Mailing Address - Phone:858-309-6300
Mailing Address - Fax:858-309-6291
Practice Address - Street 1:3750 CONVOY ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3738
Practice Address - Country:US
Practice Address - Phone:858-292-4313
Practice Address - Fax:858-292-1612
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2012-10-19
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Provider Licenses
StateLicense IDTaxonomies
CAG38495207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G384950Medicaid