MEDICARE: DR. DERIK J BROWN DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	00299	KY
2	213ES0103X	Foot & Ankle Surgery Podiatrist	312	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM005A29	OTHER	NM	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285637041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DERIK J BROWN DPM

Provider Business Mailing Address
First Line	:	1016 W PIERCE ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-4013
Country	:	US
Telephone Number	:	575-885-3445
Fax Number	:	575-887-0163

Provider Business Practice Location Address
First Line	:	1016 W PIERCE ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-4013
Country	:	US
Telephone Number	:	575-885-3445
Fax Number	:	575-887-0163

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/05/2010

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Directions to “ DR. DERIK J BROWN DPM” Practice Location

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