MEDICARE: DR. JACK HOWARD BROWN JR. MD, DPM

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	207Q00000X	Family Medicine Physician	16933	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982699096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK HOWARD BROWN JR. MD, DPM

Provider Business Mailing Address
First Line	:	PO BOX 1147
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-1147
Country	:	US
Telephone Number	:	918-246-3456
Fax Number	:	918-246-3457

Provider Business Practice Location Address
First Line	:	200 N MAIN ST STE D
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-7650
Country	:	US
Telephone Number	:	918-246-3456
Fax Number	:	918-246-3457

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	01/16/2020

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