Healthcare Provider Details

I. General information

NPI: 1801372750
Provider Name (Legal Business Name): BROWN PHYSICIAN GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 W SECOND ST STE 101
LEXINGTON KY
40508-1275
US

IV. Provider business mailing address

318 S MILL ST
LEXINGTON KY
40508-2532
US

V. Phone/Fax

Practice location:
  • Phone: 859-687-6595
  • Fax: 859-403-3015
Mailing address:
  • Phone: 859-687-6595
  • Fax: 859-403-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CADY BROWN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 859-687-6595