1598858896 NPI number — SCOTT LOGAN BROWN, MD, A PROFESSIONAL CORP

Table of content: (NPI 1598858896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598858896 NPI number — SCOTT LOGAN BROWN, MD, A PROFESSIONAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT LOGAN BROWN, MD, A PROFESSIONAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1598858896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8881 FLETCHER PKWY STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91942-3191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-828-1000
Provider Business Mailing Address Fax Number:
619-828-1001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8881 FLETCHER PKWY STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-828-1000
Provider Business Practice Location Address Fax Number:
619-828-1001
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
LOGAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
619-828-1000

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  G85788 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0071060 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com