Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 54100 | TN |
N | 207SG0201X | Clinical Genetics (M.D.) | K3112 | TX |
N | 208000000X | Pediatrician | 54100 | TN |
N | 208000000X | Pediatrician | K3112 | TX |
NPI | 1447330873 |
---|---|
Provider Name | Chester Brown |
First Address | Memphis, TN 38105-4607 |
Second Address | Memphis, TN 38105-4625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 13/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G65030 | (02) |