Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 036-117704 | IL |
NPI | 1659597524 |
---|---|
Provider Name | Dr. Derek Joseph Brown |
First Address | Emporia, KS 66801-2504 |
Second Address | Emporia, KS 66801-2589 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 02/04/2012 |