MEDICARE: DR. BLAIR JORDON 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	390200000X	Student in an Organized Health Care Education/Training Program	209949	NC
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	2020-03619	NC
3	207R00000X	Internal Medicine Physician	209949	NC

General Provider Information

NPI Number	:	1861874539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAIR JORDON BROWN M.D.

Provider Business Mailing Address
First Line	:	5172 OLD PLANTATION CIR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-4410
Country	:	US
Telephone Number	:	828-244-5592
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 LYNDHURST AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-4026
Country	:	US
Telephone Number	:	336-765-0383
Fax Number	:

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

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	11/27/2023

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