Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | LNO 5761 | AL |
NPI | 1245543461 |
---|---|
Provider Name | Dr. Harris Radcliff Brown JR. |
First Address | Mobile, AL 36652-2867 |
Second Address | Mobile, AL 36603-5827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2010 |
Last Update Date | 16/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011846 | MEDICARE GROUP PAYEE NUMBER (01) | AL |
1063439065 | GROUP NPI PAYEE NUMBER (01) | AL |