=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699862839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERRY M. BROWN, M.D. APMC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2006
-----------------------------------------------------
Last Update Date | 03/30/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 N MAGDALEN SQ
-----------------------------------------------------
City | ABBEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70510-4645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-289-8972
-----------------------------------------------------
Fax | 337-289-8970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 N. MAGDALEN SQUARE
-----------------------------------------------------
City | ABBEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70510-7645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-893-4452
-----------------------------------------------------
Fax | 337-893-7870
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KERRY M BROWN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 337-893-4452
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number | 16581
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------