Provider Demographics
NPI:1548084627
Name:BROWN, DEOIZ SR
Entity type:Individual
Prefix:MR
First Name:DEOIZ
Middle Name:
Last Name:BROWN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16104 PARASOL TREE PL APT 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7473
Mailing Address - Country:US
Mailing Address - Phone:330-622-0630
Mailing Address - Fax:
Practice Address - Street 1:16104 PARASOL TREE PL APT 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7473
Practice Address - Country:US
Practice Address - Phone:330-622-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization