Provider Demographics
NPI:1992024640
Name:BROWN, ISRAEL K (DO)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:K
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ISRAEL
Other - Middle Name:KWAME OB
Other - Last Name:BRANTUOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1070 N DEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7040
Mailing Address - Country:US
Mailing Address - Phone:559-466-7100
Mailing Address - Fax:559-466-7102
Practice Address - Street 1:2137 HERNDON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6306
Practice Address - Country:US
Practice Address - Phone:559-466-7100
Practice Address - Fax:559-466-7102
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003179207V00000X
CA20A11716207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1992024640Medicaid
P00836335OtherRAILROAD MEDICARE
MO431560263OtherTRICARE WEST
MO1992024640Medicaid