Provider Demographics
NPI:1700094695
Name:ROWE BROWN, BENJAMINA N (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMINA
Middle Name:N
Last Name:ROWE BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:BENJAMINA
Other - Middle Name:N
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 22075
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2075
Mailing Address - Country:US
Mailing Address - Phone:503-659-4777
Mailing Address - Fax:503-652-5223
Practice Address - Street 1:6327 SE MILWAUKIE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5418
Practice Address - Country:US
Practice Address - Phone:503-659-4988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR43593207Q00000X
CAC151947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR43593OtherMEDICAL LICENSE
OR272394Medicaid
OR338999000001OtherPROVIDENCE HEALTH PLANS
OR43593OtherMEDICAL LICENSE