Healthcare Provider Details

I. General information

NPI: 1831199702
Provider Name (Legal Business Name): GEORGE R BROWN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST SUITE 6252
DAYTON OH
45409-2939
US

IV. Provider business mailing address

1255 ROBERT DICKEY PKWY
DAYTON OH
45409-2120
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6060
  • Fax: 937-208-6061
Mailing address:
  • Phone: 937-208-6060
  • Fax: 937-208-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35-033166 B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: