=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245233980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN FRANK BROWN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2005
-----------------------------------------------------
Last Update Date | 08/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2812 SILVER CREEK RD
-----------------------------------------------------
City | BULLHEAD CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86442-8309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-763-7404
-----------------------------------------------------
Fax | 928-763-9795
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3880 STOCKTON HILL RD SUITE 103-135
-----------------------------------------------------
City | KINGMAN
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86409-0595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-377-9182
-----------------------------------------------------
Fax | 702-900-9648
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4550
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------