1356332092 NPI number — EILEEN LUQUE BROWN MD

Table of content: EILEEN LUQUE BROWN MD (NPI 1356332092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356332092 NPI number — EILEEN LUQUE BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
EILEEN
Provider Middle Name:
LUQUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUQUE SOSSA
Provider Other First Name:
EILEEN
Provider Other Middle Name:
AMPARO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356332092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 E PALMETTO ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29506-2851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-667-9414
Provider Business Mailing Address Fax Number:
843-667-4133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 E CHEVES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29506-2616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-667-9414
Provider Business Practice Location Address Fax Number:
843-667-4133
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  35235 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 352353 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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