MEDICARE: SAMUEL DEAN BROWN MD

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	207R00000X	Internal Medicine Physician	17486	OK

General Provider Information

NPI Number	:	1356340087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL DEAN BROWN MD

Provider Business Mailing Address
First Line	:	226 SE DEBELL AVE
Second Line	:	BLDG B
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2300
Country	:	US
Telephone Number	:	918-331-1070
Fax Number	:	918-331-1076

Provider Business Practice Location Address
First Line	:	226 SE DEBELL AVE
Second Line	:	BLDG. B
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2300
Country	:	US
Telephone Number	:	918-331-1070
Fax Number	:	918-331-1076

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	01/23/2014

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