Provider Demographics
NPI:1538167903
Name:BROWN, IAN CRAIG (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:CRAIG
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:800-883-7243
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:2160 W GRANT LINE RD STE 120
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7331
Practice Address - Country:US
Practice Address - Phone:209-836-5680
Practice Address - Fax:209-836-5778
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74032207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG59125Medicare UPIN
CA00G740321Medicare PIN
CA050056953Medicare PIN