Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 41367 | MO |
N | 1223X0400X | Orthodontists | 63401 | CA |
NPI | 1003177783 |
---|---|
Provider Name | Dr. Evan William Brown |
First Address | Saint Charles, MO 63303-5615 |
Second Address | Saint Charles, MO 63303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 19/08/2019 |