Healthcare Provider Details

I. General information

NPI: 1497753735
Provider Name (Legal Business Name): BROWN ORTHOPAEDIC SURGERY & SPORTS MEDICINE CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 ATTAIN ST
FUQUAY VARINA NC
27526-1972
US

IV. Provider business mailing address

605 ATTAIN ST
FUQUAY VARINA NC
27526-1972
US

V. Phone/Fax

Practice location:
  • Phone: 919-561-3139
  • Fax: 919-557-9251
Mailing address:
  • Phone: 919-561-3139
  • Fax: 919-557-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number200001043475
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number200001043475
License Number StateNC

VIII. Authorized Official

Name: HOWARD RICHARD BROWN
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 910-891-2677