Healthcare Provider Details

I. General information

NPI: 1992725519
Provider Name (Legal Business Name): RANDALL J BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 MAY ST
MARYSVILLE KS
66508-1200
US

IV. Provider business mailing address

1902 MAY ST
MARYSVILLE KS
66508-1200
US

V. Phone/Fax

Practice location:
  • Phone: 785-562-3942
  • Fax: 785-562-5149
Mailing address:
  • Phone: 785-562-3942
  • Fax: 785-562-5149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number419667
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: