MEDICARE: DR. RYAN DAVID BROWN M.D.

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
1	208000000X	Pediatrics Physician	22346	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154394369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN DAVID BROWN M.D.

Provider Business Mailing Address
First Line	:	3812 WARRINGTON WAY
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73072-0219
Country	:	US
Telephone Number	:	405-579-2552
Fax Number	:	405-271-2228

Provider Business Practice Location Address
First Line	:	1200 EVERETT DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5047
Country	:	US
Telephone Number	:	405-271-2429
Fax Number	:	405-271-2421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	03/14/2011

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