Healthcare Provider Details

I. General information

NPI: 1205037470
Provider Name (Legal Business Name): TY BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CHANCELLOR DRIVE
CRESTVIEW HILLS KY
41017-5466
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-957-0052
  • Fax: 859-957-0054
Mailing address:
  • Phone: 859-957-0052
  • Fax: 859-957-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number41471
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: