MEDICARE: DR. PAYTON GORDON BROWN MD

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	2084P0800X	Psychiatry Physician	01043159A	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01043159A	OTHER	IN	MD LICENSE - INDIANA

General Provider Information

NPI Number	:	1669434361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAYTON GORDON BROWN MD

Provider Business Mailing Address
First Line	:	1485 M 139
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-5711
Country	:	US
Telephone Number	:	269-925-0585
Fax Number	:	269-925-0070

Provider Business Practice Location Address
First Line	:	769 W BLAINE ST STE B
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-3970
Country	:	US
Telephone Number	:	951-358-4705
Fax Number	:	513-584-7199

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	06/04/2021

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