MEDICARE: DR. PERRY E. BROWN PH.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	103TC0700X	Clinical Psychologist	498	KY

General Provider Information

NPI Number	:	1801885546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PERRY E. BROWN PH.D.

Provider Business Mailing Address
First Line	:	815 JAIRUS DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-5526
Country	:	US
Telephone Number	:	859-576-8330
Fax Number	:	888-201-8541

Provider Business Practice Location Address
First Line	:	815 JAIRUS DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-5526
Country	:	US
Telephone Number	:	859-576-8330
Fax Number	:	888-201-8541

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

Provider Enumeration Date	:	10/16/2005
Last Update Date	:	07/08/2009

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