MEDICARE: KENNETH W BROWN D.O.

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	207Q00000X	Family Medicine Physician	34.016507	OH

General Provider Information

NPI Number	:	1497384507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH W BROWN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 1595
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41105-1595
Country	:	US
Telephone Number	:	606-408-6200
Fax Number	:	606-408-6612

Provider Business Practice Location Address
First Line	:	14395 STATE ROUTE 93
Second Line	:
City	:	JACKSON
State	:	OH
Zip	:	45640-9798
Country	:	US
Telephone Number	:	740-288-7681
Fax Number	:	740-288-7682

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

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	08/01/2023

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