Provider Demographics
NPI:1184652364
Name:BROWN, DAVID J (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BROWN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2960 E. ST. LUKE'S ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9005
Mailing Address - Country:US
Mailing Address - Phone:208-378-4264
Mailing Address - Fax:208-957-6891
Practice Address - Street 1:2960 E. ST. LUKE'S ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9005
Practice Address - Country:US
Practice Address - Phone:208-378-4264
Practice Address - Fax:208-957-6891
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-95672083B0002X
IDM9567208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM9567OtherSTATE LICENSE #