MEDICARE: BEVERLY L 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	208000000X	Pediatrics Physician	MD118288	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	603530	OTHER	MO	ANTHEM BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	370014233	OTHER	MO	RR MCR
5	411453	OTHER		HEALTHLINK

General Provider Information

NPI Number	:	1821026543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY L BROWN MD

Provider Business Mailing Address
First Line	:	PO BOX 801143
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1143
Country	:	US
Telephone Number	:	573-331-5583
Fax Number	:	573-331-5079

Provider Business Practice Location Address
First Line	:	3250 GORDONVILLE RD STE 301
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-5095
Country	:	US
Telephone Number	:	573-334-9641
Fax Number	:	573-331-4130

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	01/14/2021

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Directions to “ BEVERLY L BROWN MD” Practice Location

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