Healthcare Provider Details

I. General information

NPI: 1124114863
Provider Name (Legal Business Name): LARRY DALE BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DALE BROWN MD

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 STATE FARM PKWY
BIRMINGHAM AL
35209-7181
US

IV. Provider business mailing address

200 WILDWOOD PKWY STE 100B
BIRMINGHAM AL
35209-7300
US

V. Phone/Fax

Practice location:
  • Phone: 205-943-4600
  • Fax: 205-943-4660
Mailing address:
  • Phone: 205-943-4600
  • Fax: 205-943-4688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD.27550
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: