Healthcare Provider Details

I. General information

NPI: 1134473648
Provider Name (Legal Business Name): JOEL RAY BROWN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE 90H HOME OXYGEN DEPARTMENT
JACKSON MS
39216-5116
US

IV. Provider business mailing address

1500 E WOODROW WILSON AVE 90H HOME OXYGEN DEPARTMENT
JACKSON MS
39216-5116
US

V. Phone/Fax

Practice location:
  • Phone: 601-364-1378
  • Fax:
Mailing address:
  • Phone: 601-364-1378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number44508
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: