Provider Demographics
NPI:1235676578
Name:BROWN, IAN (PA-C)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 OBERLIN ROAD
Mailing Address - Street 2:#200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605
Mailing Address - Country:US
Mailing Address - Phone:919-322-4722
Mailing Address - Fax:
Practice Address - Street 1:815 OBERLIN ROAD
Practice Address - Street 2:#200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605
Practice Address - Country:US
Practice Address - Phone:919-322-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant