Healthcare Provider Details

I. General information

NPI: 1699938316
Provider Name (Legal Business Name): DR. LAURA R BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST STE 400
PEORIA IL
61606-2036
US

IV. Provider business mailing address

1001 MAIN ST STE 400
PEORIA IL
61606-2036
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-4005
  • Fax: 309-691-6144
Mailing address:
  • Phone: 309-691-4005
  • Fax: 309-691-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301091898
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.126725
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036161808
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4301091898
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number35.126725
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036161808
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: