MEDICARE: MR. PAUL FERGUSON BROWN JR.

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	376J00000X	Homemaker	SY287737	OH

General Provider Information

NPI Number	:	1376387373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL FERGUSON BROWN JR.

Provider Business Mailing Address
First Line	:	2238 SALVADOR ST APT A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-5305
Country	:	US
Telephone Number	:	513-601-7891
Fax Number	:

Provider Business Practice Location Address
First Line	:	2238 SALVADOR ST APT A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-5305
Country	:	US
Telephone Number	:	513-601-7891
Fax Number	:

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

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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