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NPI Code Detail

MEDICARE: DYLAN RICHARD BROWN

MEDICARE: DYLAN RICHARD 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
1246ZX2200XOrthopedic AssistantIN

General Provider Information

NPI Number : 1093374530
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYLAN RICHARD BROWN
Provider Business Mailing Address
First Line : 107 BUFFALO DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46217-5001
Country : US
Telephone Number : 317-796-2566
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E HANNA AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-3697
Country : US
Telephone Number : 317-788-3437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2019
Last Update Date : 06/09/2019

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Directions to “ DYLAN RICHARD BROWN ” Practice Location

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