1902883507 NPI number — DOUGLAS R BROWN D.O.

Table of content: DOUGLAS R BROWN D.O. (NPI 1902883507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902883507 NPI number — DOUGLAS R BROWN D.O.

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:
D.O.
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:
1902883507
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 HOMESTEAD POINTE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORRVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44667-9283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-683-3966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
365 S CROWN HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORRVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44667-9527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-682-3075
Provider Business Practice Location Address Fax Number:
330-682-7454
Provider Enumeration Date:
12/27/2005

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: 207Q00000X , with the licence number:  34002356 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000127743 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: Q012547A . This is a "HOMETOWN HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: Q012547A . This is a "HOMETOWN SECURE CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 020488800 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000180216 . This is a "UNISON HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 560 . This is a "SUMMACARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0284697 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341131413B . This is a "AULTCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 734829 . This is a "BUCKEYE HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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