Healthcare Provider Details

I. General information

NPI: 1083614291
Provider Name (Legal Business Name): DAVID EDWARD BROWN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SE 15TH RD
LAMAR MO
64759-9272
US

IV. Provider business mailing address

PO BOX 607
LAMAR MO
64759-0607
US

V. Phone/Fax

Practice location:
  • Phone: 417-681-5284
  • Fax: 417-681-5505
Mailing address:
  • Phone: 913-904-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberKS0520825
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR8707
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: