Healthcare Provider Details

I. General information

NPI: 1790994333
Provider Name (Legal Business Name): KEVIN F BROWN DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8338 W 13TH ST N
WICHITA KS
67212-2900
US

IV. Provider business mailing address

PO BOX 1560
LAS CRUCES NM
88004-1560
US

V. Phone/Fax

Practice location:
  • Phone: 316-729-9999
  • Fax: 575-647-8381
Mailing address:
  • Phone: 575-647-8366
  • Fax: 575-647-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA-1315-05
License Number StateNM

VIII. Authorized Official

Name: TRACY GEIGER
Title or Position: CREDENTIALING
Credential:
Phone: 575-647-8366