Healthcare Provider Details

I. General information

NPI: 1659355774
Provider Name (Legal Business Name): PAUL E BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 EASTERN PKWY G58
LOUISVILLE KY
40217
US

IV. Provider business mailing address

2020 EXETER RD
GERMANTOWN TN
38138-3945
US

V. Phone/Fax

Practice location:
  • Phone: 502-452-9567
  • Fax: 502-473-0586
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number24669
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: