Basic Information
| Provider Information | |||||||||
| NPI: | 1750379509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | BENNIE | ||||||||
| MiddleName: | LEONARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33255 9TH ST | ||||||||
| Address2: | |||||||||
| City: | UNION CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945872137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104715880 | ||||||||
| FaxNumber: | 5104719051 | ||||||||
| Practice Location | |||||||||
| Address1: | 33255 9TH ST | ||||||||
| Address2: | |||||||||
| City: | UNION CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945872137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104715880 | ||||||||
| FaxNumber: | 5104719051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A30405 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.