Active NPI
Russell Edan Brower, M.D.
- Internal Medicine Physician
- Laguna Beach, CA
National Provider Identifier
1104482785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- G55747
- Practice address
- 639 Virginia Park Dr
Laguna Beach, CA 92651-1950 - Phone
- (949) 315-5528
- NPI assigned
- May 19, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | G55747 | CA | Primary |
Addresses
Primary practice location
639 Virginia Park Dr
Laguna Beach, CA 92651-1950
Mailing address
639 Virginia Park Dr
Laguna Beach, CA 92651-1950
Phone (949) 315-5528
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G55747 | CA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558224000000",
"number": "1104482785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "639 VIRGINIA PARK DR",
"city": "LAGUNA BEACH",
"state": "CA",
"postal_code": "926511950",
"telephone_number": "949-315-5528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "639 VIRGINIA PARK DR",
"city": "LAGUNA BEACH",
"state": "CA",
"postal_code": "926511950",
"telephone_number": "949-315-5528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWER",
"first_name": "RUSSELL",
"middle_name": "EDAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-19",
"last_updated": "2019-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "G55747",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laguna Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.