Healthcare Provider Details

I. General information

NPI: 1689625543
Provider Name (Legal Business Name): DESRENE K BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 HARMON RD
BLUFFTON OH
45817
US

IV. Provider business mailing address

547 HARMON RD PO BOX 129
BLUFFTON OH
45817
US

V. Phone/Fax

Practice location:
  • Phone: 419-369-4600
  • Fax: 419-369-4603
Mailing address:
  • Phone: 419-369-4600
  • Fax: 419-369-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35076441
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: