Provider Demographics
NPI:1205153715
Name:BROWN, DAVID JOSEPH (CST/CFA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOSEPH
Last Name:BROWN
Suffix:
Gender:M
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14835 MONITOR MCKEE RD NE
Mailing Address - Street 2:
Mailing Address - City:MOUNT ANGEL
Mailing Address - State:OR
Mailing Address - Zip Code:97362-9643
Mailing Address - Country:US
Mailing Address - Phone:503-634-2525
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:14835 MONITOR MCKEE RD NE
Practice Address - Street 2:
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362-9643
Practice Address - Country:US
Practice Address - Phone:503-634-2525
Practice Address - Fax:888-329-6432
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR246ZS0410X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist