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General NPI Number Information
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NPI Number | 1316579022
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Entity Type | Individual
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Provider Name | MR. CLARK EDWARD BROWN
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Gender | Male
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 181309 N 2650 RD
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City | WALTERS
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State | OK
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Zip | 73572-3913
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Country | US
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Telephone | 580-351-8315
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Fax |
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Provider Business Mailing Address
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Address Line | 181309 N 2650 RD
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City | WALTERS
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State | OK
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Zip | 73572-3913
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Country | US
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Telephone | 580-351-8315
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Fax |
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | GAAA-NJRV-HY5Z
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License Number State | OK
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