Provider Demographics
NPI:1265078984
Name:BROWN, DAMON E SR
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:E
Last Name:BROWN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11522 JOSHUA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-9287
Mailing Address - Country:US
Mailing Address - Phone:760-220-6433
Mailing Address - Fax:760-990-5663
Practice Address - Street 1:11522 JOSHUA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-9287
Practice Address - Country:US
Practice Address - Phone:760-220-6433
Practice Address - Fax:760-990-5663
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver