1780063099 NPI number — MR. JEVON JAMES YARDLEY BROWN M.D (MEDICAL DOCTORA

Table of content: MR. JEVON JAMES YARDLEY BROWN M.D (MEDICAL DOCTORA (NPI 1780063099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780063099 NPI number — MR. JEVON JAMES YARDLEY BROWN M.D (MEDICAL DOCTORA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
JEVON
Provider Middle Name:
JAMES YARDLEY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D (MEDICAL DOCTORA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780063099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4728 40TH AVE NE - 1A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-327-4232
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1403 29TH STREET N.W
Provider Second Line Business Practice Location Address:
FMC-RM 382
Provider Business Practice Location Address City Name:
CALGARY
Provider Business Practice Location Address State Name:
ALBERTA
Provider Business Practice Location Address Postal Code:
T2N 2T9
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
403-944-1110
Provider Business Practice Location Address Fax Number:
403-944-2840
Provider Enumeration Date:
05/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  60557019 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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