1992786354 NPI number — TERRY L BROWN OD

Table of content: TERRY L BROWN OD (NPI 1992786354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992786354 NPI number — TERRY L BROWN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
TERRY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1992786354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 460
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50129-0460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-386-8196
Provider Business Mailing Address Fax Number:
515-386-8921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 E LINCOLNWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50129-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-386-8196
Provider Business Practice Location Address Fax Number:
515-386-8921
Provider Enumeration Date:
11/10/2005

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: 152W00000X , with the licence number:  01563 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01160 . This is a "WELLMARK BC/BS J" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 3091728 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0091728 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 026715 . This is a "HEALTH ALLIANCE JEFFERSON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 73120 . This is a "COVENTRY OSCEOLA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 41542 . This is a "WELLMARK BC/BS OSCEOLA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 35344 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 72859 . This is a "COVENTRY JEFFERSON" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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