Healthcare Provider Details

I. General information

NPI: 1568303907
Provider Name (Legal Business Name): ROBERT J BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 HIGHWAY 105 EXT STE 102
BOONE NC
28607-5682
US

IV. Provider business mailing address

355 TANGLEWOOD DR
MOUNT AIRY NC
27030-7782
US

V. Phone/Fax

Practice location:
  • Phone: 828-386-2222
  • Fax:
Mailing address:
  • Phone: 336-326-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: