Provider Demographics
NPI:1316169717
Name:BROWN, DOUGLAS WILLIAM (FNP)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:BROWN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 SW WASHINGTON ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3222
Mailing Address - Country:US
Mailing Address - Phone:503-253-6334
Mailing Address - Fax:
Practice Address - Street 1:812 SW WASHINGTON ST
Practice Address - Street 2:SUITE 610
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3222
Practice Address - Country:US
Practice Address - Phone:503-253-6334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090006597N1363LF0000X
WAAP30001769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily