Individual
BLAINE BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2101 N WATERMAN AVE, SAN BERNARDINO, CA 92404-4836
(909) 883-8711
Mailing address
3824 RIVERWOOD DR, PROVO, UT 84604-6094
(800) 883-7243
(714) 647-1245
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
179635-1205
UT
207L00000X
Anesthesiology Physician
A96642
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A966420
—
CA
01
—
P00611233
RR
—
Enumeration date
07/17/2006
Last updated
03/11/2020
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