Provider Demographics
NPI:1831179910
Name:BROWN, JAMES (PA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:6400 INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2452
Mailing Address - Country:US
Mailing Address - Phone:414-423-4100
Mailing Address - Fax:414-423-4134
Practice Address - Street 1:611 SHERMAN AVE E
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1960
Practice Address - Country:US
Practice Address - Phone:920-568-5330
Practice Address - Fax:920-568-5075
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1745-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41994400Medicaid
WI0029Medicare ID - Type Unspecified
WI41994400Medicaid