Healthcare Provider Details

I. General information

NPI: 1598339202
Provider Name (Legal Business Name): DOUGLAS BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 CAMPUS RIDGE RD
MATTHEWS NC
28105-5077
US

IV. Provider business mailing address

630 COMFORT LN STE E
MONROE NC
28112-6493
US

V. Phone/Fax

Practice location:
  • Phone: 704-234-1930
  • Fax: 704-234-1940
Mailing address:
  • Phone: 704-289-5455
  • Fax: 704-234-8341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0103080
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number96452
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2026-02193
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: