Provider Demographics
NPI:1770782013
Name:BROWN, ROBERT EDWIN (IDC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDWIN
Last Name:BROWN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NSWU 3
Mailing Address - Street 2:PCS 451 BOX 460
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09834
Mailing Address - Country:BH
Mailing Address - Phone:0119731-785-9421
Mailing Address - Fax:
Practice Address - Street 1:NSWU 3
Practice Address - Street 2:PCS 451 BOX 460
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09834
Practice Address - Country:BH
Practice Address - Phone:0119731-785-9421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman