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General NPI Number Information
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NPI Number | 1487918454
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Entity Type | Organization
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Legal Business Name | GREG BROWN, MD, LLC
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 9091 ELLERBE RD SUITE 200B
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City | SHREVEPORT
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State | LA
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Zip | 71106-6738
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Country | US
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Telephone | 318-861-3838
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Fax | 318-861-3836
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Provider Business Mailing Address
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Address Line | 9091 ELLERBE RD SUITE 200B
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City | SHREVEPORT
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State | LA
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Zip | 71106-6738
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Country | US
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Telephone | 318-861-3838
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Fax | 318-861-3836
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREG BROWN
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Credential | MD
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Telephone | 318-861-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | MD020452
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License Number State | LA
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