Provider Demographics
NPI:1508927310
Name:BROWN, BRUCE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
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 1:1330 INTERSTATE PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-5625
Mailing Address - Country:US
Mailing Address - Phone:706-651-2020
Mailing Address - Fax:706-855-6674
Practice Address - Street 1:1330 INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5625
Practice Address - Country:US
Practice Address - Phone:706-651-2020
Practice Address - Fax:706-855-6674
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055183207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4309192OtherCIGNA
GA504928015AMedicaid
GA18BDGJNOtherPTAN
GA390605OtherBLUE CROSS OF GEORGIA
7716637OtherAETNA
4309192OtherCIGNA
GA390605OtherBLUE CROSS OF GEORGIA