Individual
JACLYN RENE BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
652 E. WARNER RD., SUITE 107, GILBERT, AZ 85296-3073
(480) 539-8680
(480) 539-1763
Mailing address
652 E. WARNER RD., SUITE 107, GILBERT, AZ 85296-3073
(480) 539-8680
(480) 539-1763
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
46360
AZ
207QS0010X
Sports Medicine (Family Medicine) Physician
46360
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z67803
PTAN
AZ
Enumeration date
06/16/2009
Last updated
07/01/2014
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