Healthcare Provider Details

I. General information

NPI: 1891794350
Provider Name (Legal Business Name): SUSAN H BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W SAINT MAARTENS DR
SAINT JOSEPH MO
64506-2989
US

IV. Provider business mailing address

1009 W SAINT MAARTENS DR
SAINT JOSEPH MO
64506-2990
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-8145
  • Fax: 816-279-1840
Mailing address:
  • Phone: 816-232-8145
  • Fax: 816-279-1840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR8D62
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: