MEDICARE: DR. JORDAN DAVID 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	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	34.011770	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518305945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN DAVID BROWN D.O.

Provider Business Mailing Address
First Line	:	7700 WASHINGTON VILLAGE DR STE 130
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4094
Country	:	US
Telephone Number	:	937-531-0195
Fax Number	:	937-531-0196

Provider Business Practice Location Address
First Line	:	7700 WASHINGTON VILLAGE DR STE 130
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4094
Country	:	US
Telephone Number	:	937-531-0195
Fax Number	:	937-531-0196

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

Provider Enumeration Date	:	06/07/2013
Last Update Date	:	11/23/2020

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Directions to “ DR. JORDAN DAVID BROWN D.O.” Practice Location

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