MEDICARE: DR. JAY DOUGLAS BROWN DMD

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	122300000X	Dentist	2010009884	MO

General Provider Information

NPI Number	:	1902826167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY DOUGLAS BROWN DMD

Provider Business Mailing Address
First Line	:	6141 MID RIVERS MALL DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63304-1105
Country	:	US
Telephone Number	:	636-441-4600
Fax Number	:	636-922-2094

Provider Business Practice Location Address
First Line	:	6141 MID RIVERS MALL DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63304-1105
Country	:	US
Telephone Number	:	636-441-4600
Fax Number	:	636-922-2094

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/18/2014

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