Provider Demographics
NPI:1144316878
Name:BROWN, JEFFRY ALLEN (MD)
Entity type:Individual
Prefix:
First Name:JEFFRY
Middle Name:ALLEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1255 LAS TABLAS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9750
Mailing Address - Country:US
Mailing Address - Phone:805-434-5530
Mailing Address - Fax:805-434-0023
Practice Address - Street 1:350 POSADA LN STE 202
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4060
Practice Address - Country:US
Practice Address - Phone:805-434-5497
Practice Address - Fax:805-434-0917
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG44931207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G449310Medicaid
CA00G449310OtherMEDICARE ID
CA00G449310Medicare PIN
CAD13642Medicare UPIN