MEDICARE: DR. GARLAND RICHARD BROWN 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	2085R0202X	Diagnostic Radiology Physician	IN020308	IN

General Provider Information

NPI Number	:	1578607149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARLAND RICHARD BROWN M.D

Provider Business Mailing Address
First Line	:	5522 W HAMILTON RD S
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-9413
Country	:	US
Telephone Number	:	260-672-2049
Fax Number	:	260-427-6554

Provider Business Practice Location Address
First Line	:	1007 THREE RIVERS N
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-1334
Country	:	US
Telephone Number	:	260-422-8821
Fax Number	:	260-472-6554

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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