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General NPI Number Information
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NPI Number | 1003920034
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Entity Type | Individual
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Provider Name | RUSSELL W BROWN II PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7 S HOSPITAL DR
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City | MURPHYSBORO
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State | IL
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Zip | 62966-3333
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Country | US
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Telephone | 618-519-9200
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Fax | 618-687-1859
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Provider Business Mailing Address
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Address Line | 109 CALIFORNIA ST PO BOX 577
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City | CARTERVILLE
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State | IL
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Zip | 62918-0577
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Country | US
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Telephone | 618-519-9200
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Fax | 618-985-4635
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085002271
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License Number State | IL
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