Provider Demographics
NPI:1861555237
Name:BROWN, DONALD JEFFREY (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JEFFREY
Last Name:BROWN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 PARKLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101
Mailing Address - Country:US
Mailing Address - Phone:505-762-8890
Mailing Address - Fax:505-762-8892
Practice Address - Street 1:818 PARKLAND DRIVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:505-762-8890
Practice Address - Fax:505-762-8892
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA101294207N00000X
TXK6817207N00000X
ALD0417207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM024070OtherBCBS
NMNM024070OtherBCBS