Provider Demographics
NPI:1194933796
Name:BROWN, JOHN DENNIS (IDC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DENNIS
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:COMEXSTRIKGRU 7
Mailing Address - Street 2:UNIT 25093
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96601-6006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COMEXSTRIKGRU 7
Practice Address - Street 2:UNIT 25093
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96601-6006
Practice Address - Country:US
Practice Address - Phone:0118198-954-1639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman