1306878814 NPI number — S DEAN BROWN M D P C

Table of content: (NPI 1306878814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306878814 NPI number — S DEAN BROWN M D P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S DEAN BROWN M D P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1306878814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RR 1 BOX 122B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASHION
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73016-9731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-433-5607
Provider Business Mailing Address Fax Number:
405-433-5622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7530 NW 23RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHANY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73008-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-787-4592
Provider Business Practice Location Address Fax Number:
405-516-4468
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-787-4592

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  13737 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200069020A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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