MEDICARE: DR. GARY L BROWN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6182	KS

General Provider Information

NPI Number	:	1104815646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY L BROWN D.D.S.

Provider Business Mailing Address
First Line	:	26 GOLFVIEW DR
Second Line	:
City	:	FORT SCOTT
State	:	KS
Zip	:	66701-4603
Country	:	US
Telephone Number	:	620-223-6518
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 E WALL ST
Second Line	:
City	:	FORT SCOTT
State	:	KS
Zip	:	66701-1422
Country	:	US
Telephone Number	:	620-223-0130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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