Healthcare Provider Details

I. General information

NPI: 1245233980
Provider Name (Legal Business Name): KEVIN FRANK BROWN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2005
Last Update Date: 08/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 SILVER CREEK RD
BULLHEAD CITY AZ
86442-8309
US

IV. Provider business mailing address

3880 STOCKTON HILL RD SUITE 103-135
KINGMAN AZ
86409-0595
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-7404
  • Fax: 928-763-9795
Mailing address:
  • Phone: 928-377-9182
  • Fax: 702-900-9648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4550
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: