Healthcare Provider Details

I. General information

NPI: 1588660641
Provider Name (Legal Business Name): YOLETTE V BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 BIDDLE ST
SAINT LOUIS MO
63106-3454
US

IV. Provider business mailing address

1335 PURDUE AVE
SAINT LOUIS MO
63130-1813
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-8515
  • Fax: 314-814-8542
Mailing address:
  • Phone: 314-241-2200
  • Fax: 314-814-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD36452
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: