1265545412 NPI number — JERRY W BROWN O.D.

Table of content: JERRY W BROWN O.D. (NPI 1265545412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265545412 NPI number — JERRY W BROWN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
JERRY
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
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:
1265545412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1390 HIGHWAY F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNESVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-774-2040
Provider Business Mailing Address Fax Number:
573-774-6152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1390 HIGHWAY F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-774-2040
Provider Business Practice Location Address Fax Number:
573-774-6152
Provider Enumeration Date:
08/15/2006

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: 152W00000X , with the licence number:  T03398MO , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0431157294 . This is a "UNITED COMMERCIAL TRAVELERS OF AMERICA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "BLUE CROSS BLUE SHIELD FEDERAL EMPLOYEE PROGRAM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "MERITAIN HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431157294 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431157294 . This is a "ANTHEM BLUECROSS BLUESHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 596488 . This is a "COVENTRY HEALTH AND LIFE INSURANCE COMPANY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "AMERICAN REPUBLIC INSURANCE COMPANY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431157294 . This is a "UMR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431157294 A . This is a "HUMANA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "COOPERATIVE BENEFIT ADMINISTRATORS, INC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1598945859 . This is a "CHAMPVA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2195676 . This is a "MAIL HANDLERS BENEFIT PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 410046201 . This is a "PALMETTO GBA - RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 431157294 0005 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000000414171 . This is a "ANTHEM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 002000052183 . This is a "CARE IMPROVEMENT PLUS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 002613709 . This is a "APWU HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1265545412 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1598945859 . This is a "PALMETTO GBA - RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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