Provider Demographics
NPI:1831524875
Name:BROWN, REGAN R (PA-C)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:R
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5901 N LIDGERWOOD ST STE 118
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 W IRONWOOD DR STE 275
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4400
Practice Address - Country:US
Practice Address - Phone:208-625-4780
Practice Address - Fax:208-625-4781
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA.60411367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant