Basic Information
Provider Information
NPI: 1003296328
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: BRYAN
MiddleName: DAVID
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 W ARBOR DR # MC8829
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921031911
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 200 W ARBOR DR # MC8829
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921031911
CountryCode: US
TelephoneNumber: 6195437242
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/02/2015
LastUpdateDate: 09/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XTRN21696FLN Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207XS0106XFB9632781CAY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery

ID Information
IDTypeStateIssuerDescription
TRN2169601FLTRAINING REGISTRATION NUMBEROTHER


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