Provider Demographics
NPI:1669980272
Name:KEVIN F BROWN DO LLC
Entity type:Organization
Organization Name:KEVIN F BROWN DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NARGUESS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DADFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:818-518-7226
Mailing Address - Street 1:21419 N. PALM DESERT
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3700 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1253
Practice Address - Country:US
Practice Address - Phone:623-200-2397
Practice Address - Fax:818-671-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005311208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005311OtherMEDICAL LICENSE