Healthcare Provider Details

I. General information

NPI: 1891746913
Provider Name (Legal Business Name): DOUGLAS KEITH BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N HOSPITAL DR
GIRARD KS
66743-2000
US

IV. Provider business mailing address

302 N HOSPITAL DR
GIRARD KS
66743-2000
US

V. Phone/Fax

Practice location:
  • Phone: 620-724-8291
  • Fax: 620-724-6332
Mailing address:
  • Phone: 620-724-8291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0429439
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: