Provider Demographics
NPI:1316441793
Name:BROWN, MITCHELL EVAN (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:EVAN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:41544 MARGARITA RD APT 312
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-2937
Mailing Address - Country:US
Mailing Address - Phone:310-990-8891
Mailing Address - Fax:
Practice Address - Street 1:28400 MCCALL BLVD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-9537
Practice Address - Country:US
Practice Address - Phone:310-990-8891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA174271207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine