MEDICARE: MR. JAMES GERARD BROWN C.R.N.A.

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	367500000X	Certified Registered Nurse Anesthetist	4704122233	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	037130	OTHER		C.R.N.A./A.A.N.A.

General Provider Information

NPI Number	:	1932292596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES GERARD BROWN C.R.N.A.

Provider Business Mailing Address
First Line	:	2100 MERRILL RD.
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854
Country	:	US
Telephone Number	:	517-282-6665
Fax Number	:

Provider Business Practice Location Address
First Line	:	FOOTE HOSP., 205 NORTH EAST AVENUE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1753
Country	:	US
Telephone Number	:	517-788-4963
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/31/2021

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