Healthcare Provider Details

I. General information

NPI: 1700881364
Provider Name (Legal Business Name): TERRY RAY BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 1ST AVE W
JASPER IN
47546-3217
US

IV. Provider business mailing address

1025 1ST AVE W
JASPER IN
47546-3217
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-6066
  • Fax: 812-482-6201
Mailing address:
  • Phone: 812-482-6066
  • Fax: 812-482-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01027510
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: