MEDICARE: ROY ROBERT BROWN D.M.D.

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	7692	AZ

General Provider Information

NPI Number	:	1386792059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY ROBERT BROWN D.M.D.

Provider Business Mailing Address
First Line	:	521 W WETMORE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-1521
Country	:	US
Telephone Number	:	520-888-9047
Fax Number	:	520-887-1536

Provider Business Practice Location Address
First Line	:	521 W WETMORE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-1521
Country	:	US
Telephone Number	:	520-888-9047
Fax Number	:	520-887-1536

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	05/22/2009

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