Provider Demographics
NPI:1871871426
Name:GLENN H BROWN MD PLLC
Entity type:Organization
Organization Name:GLENN H BROWN MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-835-9755
Mailing Address - Street 1:1450 S DOBSON RD
Mailing Address - Street 2:320B
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4712
Mailing Address - Country:US
Mailing Address - Phone:480-835-9755
Mailing Address - Fax:480-964-8668
Practice Address - Street 1:1450 S DOBSON RD
Practice Address - Street 2:320B
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4712
Practice Address - Country:US
Practice Address - Phone:480-835-9755
Practice Address - Fax:480-964-8668
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLENN H BROWN MD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-01
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14201207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty