Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | C8155 | AR |
NPI | 1255345450 |
---|---|
Provider Name | David P Brown |
First Address | Mena, AR 71953-8417 |
Second Address | Mena, AR 71953-8417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 10/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120567001 | (05) | AR |
F10927 | (02) | AR |