Healthcare Provider Details

I. General information

NPI: 1699725044
Provider Name (Legal Business Name): BONNIE SUSANNE BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11969 S DIXIE HWY
SONORA KY
42776-9739
US

IV. Provider business mailing address

PO BOX 2309
ELIZABETHTOWN KY
42702-2309
US

V. Phone/Fax

Practice location:
  • Phone: 270-369-9706
  • Fax: 270-369-9263
Mailing address:
  • Phone: 270-706-1023
  • Fax: 270-706-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33782
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: