Healthcare Provider Details

I. General information

NPI: 1881729945
Provider Name (Legal Business Name): CHAD TEE BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 NE DOCTORS DR STE 110
BEND OR
97701-7185
US

IV. Provider business mailing address

2239 NE DOCTORS DR STE 110
BEND OR
97701-7185
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-8705
  • Fax: 541-323-8707
Mailing address:
  • Phone: 541-323-8705
  • Fax: 541-323-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD28568
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD28568
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: