Healthcare Provider Details

I. General information

NPI: 1295784684
Provider Name (Legal Business Name): BROWN FAMILY PRACTICE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N HOSPITAL DR SUITE 200
GIRARD KS
66743-2014
US

IV. Provider business mailing address

PO BOX 196
CHEROKEE KS
66724
US

V. Phone/Fax

Practice location:
  • Phone: 620-457-8100
  • Fax:
Mailing address:
  • Phone: 316-281-3700
  • Fax: 316-282-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS KEITH BROWN
Title or Position: PHYSICIAN
Credential: MD
Phone: 620-457-8100