Healthcare Provider Details

I. General information

NPI: 1427543073
Provider Name (Legal Business Name): RUDOLPH THOMAS BROWN JR. JR. BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 11/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 BARONNE ST STE 305
NEW ORLEANS LA
70113-1018
US

IV. Provider business mailing address

3308 TULANE AVE STE 407
NEW ORLEANS LA
70119-7158
US

V. Phone/Fax

Practice location:
  • Phone: 504-814-8001
  • Fax:
Mailing address:
  • Phone: 504-821-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: