1992784904 NPI number — DOUGLAS R BROWN MD

Table of content: DOUGLAS R BROWN MD (NPI 1992784904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992784904 NPI number — DOUGLAS R BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
DOUGLAS
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992784904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 PINE RIDGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUSAU
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54401-7803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-847-2022
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 PINE RIDGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54401-7803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-847-2022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2006

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: 208600000X , with the licence number:  40651 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NA2951023818 . This is a "PREFFERED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 062227300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0201111271 . This is a "BLUE CROSS PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 41084933956001C130 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62227300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122980 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP26576 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5000030 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1045807 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 020039235 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1700203 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 29B02BR . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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