Healthcare Provider Details

I. General information

NPI: 1629061080
Provider Name (Legal Business Name): DAVID J BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W 6TH ST
DERIDDER LA
70634
US

IV. Provider business mailing address

302 W 6TH ST
DERIDDER LA
70634
US

V. Phone/Fax

Practice location:
  • Phone: 337-463-8556
  • Fax: 337-463-8561
Mailing address:
  • Phone: 337-463-8556
  • Fax: 337-463-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number019016
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: