Healthcare Provider Details

I. General information

NPI: 1245543461
Provider Name (Legal Business Name): HARRIS RADCLIFF BROWN JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N BAYOU ST
MOBILE AL
36603-5827
US

IV. Provider business mailing address

PO BOX 2867
MOBILE AL
36652-2867
US

V. Phone/Fax

Practice location:
  • Phone: 251-690-8139
  • Fax: 251-544-2149
Mailing address:
  • Phone: 251-690-8139
  • Fax: 251-544-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberLNO 5761
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: