Provider Demographics
NPI:1386949717
Name:BROWN, RUSSELL ALLEN (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 NETWORK CIR
Mailing Address - Street 2:SCA18-3236
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1778
Mailing Address - Country:US
Mailing Address - Phone:408-276-7728
Mailing Address - Fax:
Practice Address - Street 1:4180 NETWORK CIR
Practice Address - Street 2:SCA18-3236
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1778
Practice Address - Country:US
Practice Address - Phone:408-276-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-15
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT165689-1205207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine