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NPI Code Detail

MEDICARE: GRADY BROWN

MEDICARE: GRADY BROWN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1043095169
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRADY BROWN
Provider Business Mailing Address
First Line : PO BOX 1710
Second Line :
City : REDMOND
State : OR
Zip : 97756-0516
Country : US
Telephone Number : 541-550-1068
Fax Number : 541-385-9661
Provider Business Practice Location Address
First Line : 358 NE MARSHALL AVE
Second Line :
City : BEND
State : OR
Zip : 97701-4364
Country : US
Telephone Number : 541-550-1068
Fax Number : 541-385-9661
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2023
Last Update Date : 08/28/2023

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Directions to “ GRADY BROWN ” Practice Location

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