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General NPI Number Information
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NPI Number | 1255345195
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Entity Type | Organization
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Legal Business Name | W. BRUCE BROWN MD, PA.
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/21/2010
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Provider Practice Location Address
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Address Line | 3016 W MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2453
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Country | US
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Telephone | 479-890-2663
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Fax | 479-880-2663
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Provider Business Mailing Address
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Address Line | 3016 W MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2453
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Country | US
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Telephone | 479-890-2663
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Fax | 479-880-2663
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM BRUCE BROWN
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Credential | MD
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Telephone | 479-890-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | C6797
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License Number State | AR
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