Provider Demographics
NPI:1720135346
Name:BROWN, GREG A (MD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:A
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:655 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 124
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2809
Mailing Address - Country:US
Mailing Address - Phone:949-661-9657
Mailing Address - Fax:949-661-1352
Practice Address - Street 1:655 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 124
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2809
Practice Address - Country:US
Practice Address - Phone:949-661-9657
Practice Address - Fax:949-661-1352
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA40335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40335OtherLICENSE
CA00A403350Medicaid
A85437Medicare UPIN
WA40335AMedicare PIN